Healthcare Provider Details

I. General information

NPI: 1225481849
Provider Name (Legal Business Name): GHASSAN KAZMOUZ GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE W304
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

PO BOX 13773
PALM DESERT CA
92255-3773
US

V. Phone/Fax

Practice location:
  • Phone: 760-322-9562
  • Fax: 760-320-4226
Mailing address:
  • Phone: 760-322-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA66439
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA66439
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA66439
License Number StateCA

VIII. Authorized Official

Name: GHASSAN KAZMOUZ
Title or Position: OWNER-PHYSICIAN
Credential: M.D.
Phone: 760-322-9562