Healthcare Provider Details

I. General information

NPI: 1013037266
Provider Name (Legal Business Name): MAHROU - HAZEGHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S FLOWER ST
LOS ANGELES CA
90071-2101
US

IV. Provider business mailing address

505 S FLOWER ST
LOS ANGELES CA
90071-2101
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-6161
  • Fax: 213-626-6163
Mailing address:
  • Phone: 213-626-6161
  • Fax: 213-626-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: