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General NPI Number Information
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NPI Number | 1104046747
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Entity Type | Organization
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Legal Business Name | ALI R NAMAZIE MD A MEDICAL GROUP, INC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD STE 226
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City | ENCINO
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State | CA
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Zip | 91436-1947
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Country | US
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Telephone | 818-986-5500
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Fax | 818-986-5503
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Provider Business Mailing Address
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Address Line | 4955 VAN NUYS BLVD SUITE 505
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1801
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Country | US
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Telephone | 818-986-5500
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Fax | 818-986-5503
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Authorized Official
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Title or Position | PRACTICE PRESIDENT
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Name | ALI R NAMAZIE
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Credential | MD
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Telephone | 818-986-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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