Provider Demographics
NPI:1639429178
Name:GHASRI, PEDRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRAM
Middle Name:
Last Name:GHASRI
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 1:18555 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4191
Mailing Address - Country:US
Mailing Address - Phone:818-344-3376
Mailing Address - Fax:
Practice Address - Street 1:18555 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4191
Practice Address - Country:US
Practice Address - Phone:818-344-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA123798207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology