Healthcare Provider Details

I. General information

NPI: 1760797740
Provider Name (Legal Business Name): AMIR ALEX TAHBAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 02/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

571 LILLIAN WAY
LOS ANGELES CA
90004-1105
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-7557
  • Fax:
Mailing address:
  • Phone: 310-210-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA113662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: