Provider Demographics
NPI:1386675049
Name:ALIREZA KATOUZIAN, MD INC.
Entity Type:Organization
Organization Name:ALIREZA KATOUZIAN, MD INC.
Other - Org Name:ALIREZA KATOUZIAN, MD, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATOUZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-585-5201
Mailing Address - Street 1:1100 PASEO CAMARILLO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6073
Mailing Address - Country:US
Mailing Address - Phone:805-585-5201
Mailing Address - Fax:
Practice Address - Street 1:1100 PASEO CAMARILLO
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-484-8558
Practice Address - Fax:805-484-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64500207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G645000Medicaid
CA050077476OtherRAILROAD MEDICARE
CAG64500AMedicare PIN
CA050077476OtherRAILROAD MEDICARE