Healthcare Provider Details

I. General information

NPI: 1194801167
Provider Name (Legal Business Name): BEHZAD BEHMANESH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 WEST ALAMEDA AVE 604
BURBANK CA
91505-4411
US

IV. Provider business mailing address

2701 WEST ALAMEDA AVE 604
BURBANK CA
91505-4411
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-5000
  • Fax: 818-845-5004
Mailing address:
  • Phone: 818-845-5000
  • Fax: 818-845-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA052472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: