Provider Demographics
NPI:1285665224
Name:KATOUZIAN, ALIREZA (MD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:KATOUZIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PASEO CAMARILLO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6073
Mailing Address - Country:US
Mailing Address - Phone:805-585-5201
Mailing Address - Fax:805-597-8350
Practice Address - Street 1:1100 PASEO CAMARILLO
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-484-8558
Practice Address - Fax:805-484-3099
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64500208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081200Medicaid
CAGR0081302Medicaid
CA00G645000Medicaid
CABD390Medicare PIN
CA00G645000Medicaid
CAG64500AMedicare PIN
CAWG64500AMedicare PIN
CAGR0081301Medicare PIN
CAGR0081302Medicaid
CAWG64500CMedicare PIN