Provider Demographics
NPI:1346359304
Name:HAZANY, EBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:EBRAHIM
Middle Name:
Last Name:HAZANY
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 1:1000 NEWBURY RD.
Mailing Address - Street 2:#240
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-498-1400
Mailing Address - Fax:805-498-1411
Practice Address - Street 1:1000 NEWBURY RD STE 240
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6443
Practice Address - Country:US
Practice Address - Phone:805-498-1400
Practice Address - Fax:805-498-1411
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA534092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53409AMedicare ID - Type Unspecified