Provider Demographics
NPI:1811040843
Name:NAMAZIAN, MOHAMMAD (DO)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:NAMAZIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 CHURCH ST APT 2212
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8081
Mailing Address - Country:US
Mailing Address - Phone:909-244-0550
Mailing Address - Fax:909-244-0550
Practice Address - Street 1:11880 METROPOLITAN AVE APT 5F
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2063
Practice Address - Country:US
Practice Address - Phone:718-847-3635
Practice Address - Fax:718-847-3635
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9672207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery