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NPI Code Detail

MEDICARE: FARIBORZ MORTAZAVI M.D.

MEDICARE: FARIBORZ MORTAZAVI 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
1207RH0003XHematology & Oncology Physician036-107982IL
2207RH0003XHematology & Oncology PhysicianA96026CA

General Provider Information

NPI Number : 1689782708
Entity Type Code : Individual
Provider Name (Legal Business Name) : FARIBORZ MORTAZAVI M.D.
Provider Business Mailing Address
First Line : 1700 N ROSE AVE
Second Line : SUITE 320
City : OXNARD
State : CA
Zip : 93030-7648
Country : US
Telephone Number : 805-485-8709
Fax Number : 805-485-5521
Provider Business Practice Location Address
First Line : 1700 N ROSE AVE SUITE 320
Second Line :
City : OXNARD
State : CA
Zip : 93030-7648
Country : US
Telephone Number : 805-485-8709
Fax Number : 805-485-5521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2006
Last Update Date : 09/08/2016

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