Healthcare Provider Details

I. General information

NPI: 1487635546
Provider Name (Legal Business Name): GHOLAMREZA FIROUZ POURZIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 JOHNSON AVE STE 101
SAN LUIS OBISPO CA
93401-4154
US

IV. Provider business mailing address

1941 JOHNSON AVE STE 101
SAN LUIS OBISPO CA
93401-4154
US

V. Phone/Fax

Practice location:
  • Phone: 805-782-8844
  • Fax: 805-549-6985
Mailing address:
  • Phone: 805-782-8844
  • Fax: 805-549-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA45667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: