Healthcare Provider Details

I. General information

NPI: 1104046747
Provider Name (Legal Business Name): ALI R NAMAZIE MD A MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 226
ENCINO CA
91436-1947
US

IV. Provider business mailing address

4955 VAN NUYS BLVD SUITE 505
SHERMAN OAKS CA
91403-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-5500
  • Fax: 818-986-5503
Mailing address:
  • Phone: 818-986-5500
  • Fax: 818-986-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI R NAMAZIE
Title or Position: PRACTICE PRESIDENT
Credential: MD
Phone: 818-986-5500