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General NPI Number Information
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NPI Number | 1144775172
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Entity Type | Individual
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Provider Name | HAMID DAVOUDI PA
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Gender | Male
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 14925 BURBANK BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-3610
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Country | US
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Telephone | 818-905-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 822 S ROBERTSON BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90035-1630
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Country | US
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Telephone | 818-905-3355
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 53624
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License Number State | CA
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