Provider Demographics
NPI:1679713689
Name:PARISA POURZAND MD INC
Entity Type:Organization
Organization Name:PARISA POURZAND MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POURZAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-545-8322
Mailing Address - Street 1:269 S BEVERLY DR
Mailing Address - Street 2:120
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3851
Mailing Address - Country:US
Mailing Address - Phone:818-545-8322
Mailing Address - Fax:818-545-7906
Practice Address - Street 1:1141 N BRAND BLVD
Practice Address - Street 2:305
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2511
Practice Address - Country:US
Practice Address - Phone:818-545-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA80373Medicare PIN
CAI19099Medicare UPIN