=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295139996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANSOOR KARAMOOZ, M.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2014
-----------------------------------------------------
Last Update Date | 10/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 E ANGELENO AVE SUITE 202
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91501-2286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-845-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 E ANGELENO AVE SUITE 202
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91501-2286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-845-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT./OWNER
-----------------------------------------------------
Name | MANSOOR KARAMOOZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-845-6300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | A35368
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------