Healthcare Provider Details

I. General information

NPI: 1699796813
Provider Name (Legal Business Name): SHIRZAD A. ABRAMS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD SUITE 1150
ENCINO CA
91436-2124
US

IV. Provider business mailing address

16311 VENTURA BLVD SUITE 1150
ENCINO CA
91436-2124
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-5326
  • Fax: 818-501-6958
Mailing address:
  • Phone: 818-501-5326
  • Fax: 818-501-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA30870
License Number StateCA

VIII. Authorized Official

Name: ERITE DANIAL
Title or Position: BOOK KEEPER
Credential:
Phone: 818-501-5326