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General NPI Number Information
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NPI Number | 1134430606
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Entity Type | Organization
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Legal Business Name | ATA MAZAHERI MD INC.
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 1560 E CHEVY CHASE DR SUITE #450
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City | GLENDALE
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State | CA
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Zip | 91206-4197
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Country | US
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Telephone | 818-246-3300
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Fax | 818-246-3305
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Provider Business Mailing Address
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Address Line | 1560 E. CHEVY CHASE DRIVE SUITE #450
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City | GLENDALE
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State | CA
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Zip | 91206
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Country | US
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Telephone | 818-246-3300
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Fax | 818-246-3305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ATA MAZAHERI
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Credential | MD
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Telephone | 818-246-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A79930
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License Number State | CA
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