Healthcare Provider Details

I. General information

NPI: 1912030479
Provider Name (Legal Business Name): PARVIZ H GOSHTASBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 HOSPITAL RD STE 324
NEWPORT BEACH CA
92663-3524
US

IV. Provider business mailing address

361 HOSPITAL RD STE 324
NEWPORT BEACH CA
92663-3524
US

V. Phone/Fax

Practice location:
  • Phone: 949-500-5440
  • Fax: 949-548-9664
Mailing address:
  • Phone: 949-500-5440
  • Fax: 949-629-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number90268
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA110114
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number90268
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number241912-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number90268
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: