Healthcare Provider Details

I. General information

NPI: 1679045041
Provider Name (Legal Business Name): MAHSA PARVIZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4869 W SUNSET BLVD.
LOS ANGELES CA
90027-5969
US

IV. Provider business mailing address

2700 MISSION COLLEGE BLVD # C1
SANTA CLARA CA
95054-1218
US

V. Phone/Fax

Practice location:
  • Phone: 657-210-0021
  • Fax:
Mailing address:
  • Phone: 657-210-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHSA PARVIZ
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 657-210-0021