Healthcare Provider Details

I. General information

NPI: 1013690692
Provider Name (Legal Business Name): FIZZA MAHMOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE RM 115
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2020 ZONAL AVE RM 115
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-2324
  • Fax:
Mailing address:
  • Phone: 323-409-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18103
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: