Healthcare Provider Details

I. General information

NPI: 1316087133
Provider Name (Legal Business Name): DR. MOHAMMAD MEHDIZADEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S FETTERLY AVE
LOS ANGELES CA
90022-1605
US

IV. Provider business mailing address

245 S FETTERLY AVE
LOS ANGELES CA
90022-1605
US

V. Phone/Fax

Practice location:
  • Phone: 323-780-2216
  • Fax: 323-264-3771
Mailing address:
  • Phone: 323-780-2216
  • Fax: 323-264-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA30928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: