Healthcare Provider Details

I. General information

NPI: 1366833923
Provider Name (Legal Business Name): ANTHONY PIROUZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST COAST ROAD
REDWAY CA
95560
US

IV. Provider business mailing address

930 S FORTUNA BLVD
FORTUNA CA
95540-3009
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-2783
  • Fax:
Mailing address:
  • Phone: 707-353-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52315
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1963
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: