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General NPI Number Information
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NPI Number | 1558367649
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Entity Type | Organization
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Legal Business Name | SHIRAZ MEDICAL GROUP, INC
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 16952 VENTURA BLVD STE 100
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City | ENCINO
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State | CA
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Zip | 91316-4124
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Country | US
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Telephone | 818-789-3964
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Fax | 818-789-3967
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Provider Business Mailing Address
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Address Line | 16952 VENTURA BLVD STE 100
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City | ENCINO
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State | CA
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Zip | 91316-4124
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Country | US
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Telephone | 818-789-3964
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Fax | 818-789-3967
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Authorized Official
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Title or Position | CEO
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Name | KEYVAN SHIRAZI
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Credential | M.D.
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Telephone | 818-789-3964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A78184
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License Number State | CA
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