Healthcare Provider Details

I. General information

NPI: 1396906921
Provider Name (Legal Business Name): PASCAL FERZLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PACIFIC COAST HWY STE 212
SEAL BEACH CA
90740-6643
US

IV. Provider business mailing address

18782 ROXBURY LN
HUNTINGTON BEACH CA
92648-6858
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-8554
  • Fax:
Mailing address:
  • Phone: 617-947-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA125157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: