Provider Demographics
NPI:1124414743
Name:AZIZ, SEPEHR (DO)
Entity Type:Individual
Prefix:DR
First Name:SEPEHR
Middle Name:
Last Name:AZIZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:SHEPERD
Other - Middle Name:
Other - Last Name:AZIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:213-821-6500
Mailing Address - Fax:
Practice Address - Street 1:1031 W 34TH ST STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-3602
Practice Address - Country:US
Practice Address - Phone:213-764-2800
Practice Address - Fax:213-764-2888
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2646332084P0800X
CA20A165102084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry