Healthcare Provider Details

I. General information

NPI: 1871542985
Provider Name (Legal Business Name): PIRUZ BRUCE KHORVASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PIROOZ BRUCE KHORVASH

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7624 REPOSADO DR
CARLSBAD CA
92009-7928
US

IV. Provider business mailing address

7624 REPOSADO DR.
CARLSBAD CA
92009-7928
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-9950
  • Fax: 760-942-9950
Mailing address:
  • Phone: 760-942-9950
  • Fax: 760-942-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number05D0856205
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number05D085620
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA26424
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA26424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: