Healthcare Provider Details

I. General information

NPI: 1083107577
Provider Name (Legal Business Name): ASHKAN HESHMATZADEH BEHZADI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E HERNDON AVE STE 110
FRESNO CA
93720-3333
US

IV. Provider business mailing address

1111 E SPRUCE AVE STE 431
FRESNO CA
93720-3330
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-6742
  • Fax: 559-450-6743
Mailing address:
  • Phone: 559-450-7449
  • Fax: 559-450-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA193517
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA193517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: