Provider Demographics
NPI:1376501080
Name:MASOUD M AZIZAD MD INC
Entity Type:Organization
Organization Name:MASOUD M AZIZAD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:M
Authorized Official - Last Name:AZIZAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-341-4401
Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:208
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4108
Mailing Address - Country:US
Mailing Address - Phone:818-341-4401
Mailing Address - Fax:818-341-4402
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:#208
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4108
Practice Address - Country:US
Practice Address - Phone:818-341-4401
Practice Address - Fax:818-341-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61958Medicare UPIN