Healthcare Provider Details

I. General information

NPI: 1881783223
Provider Name (Legal Business Name): SOLOMON N FOROUZESH M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 604
CULVER CITY CA
90232-6820
US

IV. Provider business mailing address

9808 VENICE BLVD STE 604
CULVER CITY CA
90232-6820
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-6811
  • Fax:
Mailing address:
  • Phone: 310-204-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA30592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA30592
License Number StateCA

VIII. Authorized Official

Name: DR. SOLOMON FOROUZESH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-204-6811