Physician Compare National (NPI:1104110071)

HEALTHCARE PROVIDER: NAVID EZRA M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104110071
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204077068
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150921001683
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	EZRA
	Individual professional last name
Provider First Name	NAVID
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3095 OLD CONEJO RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	THOUSAND OAKS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913202130
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y