Healthcare Provider Details

I. General information

NPI: 1821435637
Provider Name (Legal Business Name): PANIZ HEIDARI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 N SEPULVEDA BLVD
MISSION HILLS CA
91345-1116
US

IV. Provider business mailing address

11333 SEPULVEDA BLVD
MISSION HILLS CA
91345-1116
US

V. Phone/Fax

Practice location:
  • Phone: 818-869-7256
  • Fax: 818-869-7133
Mailing address:
  • Phone: 818-869-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A15478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: