Healthcare Provider Details

I. General information

NPI: 1346702032
Provider Name (Legal Business Name): MAZEN NIZAR JIZZINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18133 VENTURA BLVD STE 300
TARZANA CA
91356-3645
US

IV. Provider business mailing address

462 GRIDER ST
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-3818
  • Fax:
Mailing address:
  • Phone: 716-898-4578
  • Fax: 898-327-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA177889
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: