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NPI Code Detail

MEDICARE: MAZIYAR SHOAEE MD

MEDICARE: MAZIYAR SHOAEE MD
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
1207R00000XInternal Medicine PhysicianA76504CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100A765040OTHERCAMEDI CAL

General Provider Information

NPI Number : 1407857154
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAZIYAR SHOAEE MD
Provider Business Mailing Address
First Line : 2925 PALO VERDE AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1552
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2925 PALO VERDE AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1552
Country : US
Telephone Number : 562-429-2473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 11/30/2021

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