Healthcare Provider Details

I. General information

NPI: 1255488029
Provider Name (Legal Business Name): DR. PAYMAN R HOSHYARSAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 VALLEY BLVD
EL MONTE CA
91732-3040
US

IV. Provider business mailing address

PO BOX 280748
NORTHRIDGE CA
91328-0748
US

V. Phone/Fax

Practice location:
  • Phone: 626-401-2775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: