Provider Demographics
NPI:1598861866
Name:DEZFULI, MASSOUD G (DO)
Entity Type:Individual
Prefix:
First Name:MASSOUD
Middle Name:G
Last Name:DEZFULI
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39700 BOB HOPE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3267
Mailing Address - Country:US
Mailing Address - Phone:760-834-3545
Mailing Address - Fax:760-834-3546
Practice Address - Street 1:39700 BOB HOPE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3267
Practice Address - Country:US
Practice Address - Phone:760-834-3545
Practice Address - Fax:760-834-3546
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5819207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330847052Medicare UPIN