MEDICARE: PARNIAN CHANGIZZADEH M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	208000000X	Pediatrics Physician	61157	AZ

General Provider Information

NPI Number	:	1205369162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARNIAN CHANGIZZADEH M.D

Provider Business Mailing Address
First Line	:	1851 MESQUITE AVE STE 202
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5681
Country	:	US
Telephone Number	:	928-854-0094
Fax Number	:	928-680-8986

Provider Business Practice Location Address
First Line	:	1851 MESQUITE AVE STE 202
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5681
Country	:	US
Telephone Number	:	928-854-0094
Fax Number	:	928-680-8986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2017
Last Update Date	:	07/23/2020

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