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General NPI Number Information
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NPI Number | 1720586225
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Entity Type | Organization
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Legal Business Name | LAILA NIAZI MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 1000 NEWBURY RD STE 100
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6436
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Country | US
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Telephone | 805-480-3730
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Fax | 805-480-1951
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Provider Business Mailing Address
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Address Line | 1000 NEWBURY RD STE 100
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6436
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Country | US
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Telephone | 805-480-3730
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Fax | 805-480-1951
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Authorized Official
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Title or Position | PHYSICIAN-DIRECTOR
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Name | DR. LAILA NIAZI
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Credential | MD
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Telephone | 805-480-3730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | A91451
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License Number State | CA
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