Healthcare Provider Details

I. General information

NPI: 1235139437
Provider Name (Legal Business Name): MEHDI IZADI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MEDICAL CENTER DR. SUITE 302
WEST HILLS CA
91307
US

IV. Provider business mailing address

7301 MEDICAL CENTER DR. SUITE 302
WEST HILLS CA
91307
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-3387
  • Fax: 818-888-3391
Mailing address:
  • Phone: 818-888-3387
  • Fax: 818-888-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE49730
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: