Provider Demographics
NPI:1912030479
Name:GOSHTASBY, PARVIZ H (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVIZ
Middle Name:H
Last Name:GOSHTASBY
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 1:361 HOSPITAL RD STE 324
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3524
Mailing Address - Country:US
Mailing Address - Phone:949-500-5440
Mailing Address - Fax:949-629-3692
Practice Address - Street 1:361 HOSPITAL RD STE 324
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3524
Practice Address - Country:US
Practice Address - Phone:949-500-5440
Practice Address - Fax:949-548-9664
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH902682082S0099X, 2082S0105X, 208200000X
CAA110114208200000X
NY241912-1207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700192754OtherPRACTICE NPI