MEDICARE: DR. BOBBY POURZIAEE D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0405	NV
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E4339	CA

General Provider Information

NPI Number	:	1922057173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY POURZIAEE D.P.M.

Provider Business Mailing Address
First Line	:	6230 WILSHIRE BLVD STE 145
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5126
Country	:	US
Telephone Number	:	310-770-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N CRESCENT DR STE 340
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4884
Country	:	US
Telephone Number	:	310-441-0088
Fax Number	:	310-388-5809

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	12/06/2022

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