Healthcare Provider Details

I. General information

NPI: 1215950647
Provider Name (Legal Business Name): RAMAZ DZHANASHVILI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 VENTURA BLVD STE 250
ENCINO CA
91316-3717
US

IV. Provider business mailing address

17777 VENTURA BLVD STE 250
ENCINO CA
91316-3717
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-8311
  • Fax: 818-654-8382
Mailing address:
  • Phone: 818-654-8311
  • Fax: 818-654-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA45389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: