Healthcare Provider Details

I. General information

NPI: 1114178076
Provider Name (Legal Business Name): TANNAZ ZAHIRPOUR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SYCAMORE DR. SUITE 204-205
SIMI VALLEY CA
93065-1207
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 805-578-9620
  • Fax: 805-583-0414
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: