Healthcare Provider Details

I. General information

NPI: 1619881612
Provider Name (Legal Business Name): MAZEN ELHOSSEINY CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 120
ENCINO CA
91436-1931
US

IV. Provider business mailing address

16661 VENTURA BLVD STE 120
ENCINO CA
91436-1931
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-6004
  • Fax: 818-907-6005
Mailing address:
  • Phone: 818-261-8028
  • Fax: 818-907-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO05895
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO05895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: