Healthcare Provider Details

I. General information

NPI: 1952382756
Provider Name (Legal Business Name): TANAZ R. FERZANDI M.D., M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/27/2023
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 SAN PABLO ST FL 3
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-3705
  • Fax:
Mailing address:
  • Phone: 323-276-3705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number226218
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC166730
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberC166730
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number226218
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: