Provider Demographics
NPI:1760493076
Name:DELSHAD, GEORGE MORDECHAI (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MORDECHAI
Last Name:DELSHAD
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 1:11951 MAYFIELD AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5968
Mailing Address - Country:US
Mailing Address - Phone:951-461-9771
Mailing Address - Fax:951-461-1462
Practice Address - Street 1:14640 PARTHENIA ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-830-6970
Practice Address - Fax:818-830-3015
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83566207V00000X
CAG083566207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G835660Medicaid
CA00G835660Medicaid
G38551Medicare UPIN