Provider Demographics
NPI:1386016202
Name:IZADSETA, KAMBIZ
Entity Type:Individual
Prefix:MR
First Name:KAMBIZ
Middle Name:
Last Name:IZADSETA
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 1:7885 ANNANDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1419
Mailing Address - Country:US
Mailing Address - Phone:760-329-2925
Mailing Address - Fax:760-329-0169
Practice Address - Street 1:7885 ANNANDALE AVE
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-1419
Practice Address - Country:US
Practice Address - Phone:760-329-2925
Practice Address - Fax:760-329-0169
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA019230615101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)