Healthcare Provider Details

I. General information

NPI: 1811143605
Provider Name (Legal Business Name): MR. PARVIZ PARIS SERVATJOO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PARVIZ PARIS SERVATJOO

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 CANBY AVE
RESEDA CA
91335-3003
US

IV. Provider business mailing address

7217 CANBY AVE
RESEDA CA
91335-3003
US

V. Phone/Fax

Practice location:
  • Phone: 818-995-4040
  • Fax: 818-996-3219
Mailing address:
  • Phone: 818-995-4040
  • Fax: 818-996-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: