Provider Demographics
NPI:1316183205
Name:KAVOOSSI, ELIZABETH VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VICTORIA
Last Name:KAVOOSSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5977 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3752
Mailing Address - Country:US
Mailing Address - Phone:562-421-3727
Mailing Address - Fax:562-420-8948
Practice Address - Street 1:5977 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3752
Practice Address - Country:US
Practice Address - Phone:562-421-3727
Practice Address - Fax:562-420-8948
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01391231OtherRR MEDICARE
CADM879YMedicare PIN