Provider Demographics
NPI:1356683932
Name:SHIRAZ, AHAD
Entity Type:Individual
Prefix:
First Name:AHAD
Middle Name:
Last Name:SHIRAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23326 HAWTHORNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3756
Mailing Address - Country:US
Mailing Address - Phone:310-257-7298
Mailing Address - Fax:310-257-3117
Practice Address - Street 1:855 MANHATTAN BEACH BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4965
Practice Address - Country:US
Practice Address - Phone:310-939-7847
Practice Address - Fax:310-939-7878
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine