Provider Demographics
NPI:1114643087
Name:GISELLE NAMAZIE MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GISELLE NAMAZIE MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:CABELLO
Authorized Official - Last Name:NAMAZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-343-0559
Mailing Address - Street 1:16661 VENTURA BLVD STE 226
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1947
Mailing Address - Country:US
Mailing Address - Phone:818-796-2070
Mailing Address - Fax:818-986-5503
Practice Address - Street 1:16661 VENTURA BLVD STE 226
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1947
Practice Address - Country:US
Practice Address - Phone:818-796-2070
Practice Address - Fax:818-986-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty