Provider Demographics
NPI:1235671389
Name:NAVID EZRA, M.D. INC
Entity Type:Organization
Organization Name:NAVID EZRA, M.D. INC
Other - Org Name:CALIFORNIA DERMATOLOGY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EZRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-222-5803
Mailing Address - Street 1:3095 OLD CONEJO RD, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2130
Mailing Address - Country:US
Mailing Address - Phone:805-222-5803
Mailing Address - Fax:805-222-0323
Practice Address - Street 1:3095 OLD CONEJO RD STE 200
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-2130
Practice Address - Country:US
Practice Address - Phone:805-222-5803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty