Provider Demographics
NPI:1629017801
Name:PARSA, KOOROS (MD)
Entity Type:Individual
Prefix:DR
First Name:KOOROS
Middle Name:
Last Name:PARSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-485-8709
Mailing Address - Fax:805-485-5521
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-485-8709
Practice Address - Fax:805-485-5521
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21697207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5628497OtherNCPDP/NPDS
110098722OtherRAILROAD MEDICARE
CA00A216970Medicaid
110098722OtherRAILROAD MEDICARE
CA5628497OtherNCPDP/NPDS
WA21697BMedicare PIN