Provider Demographics
NPI:1922057173
Name:POURZIAEE, BOBBY (DPM)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:POURZIAEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 WILSHIRE BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5126
Mailing Address - Country:US
Mailing Address - Phone:310-770-1492
Mailing Address - Fax:
Practice Address - Street 1:415 N CRESCENT DR STE 340
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4884
Practice Address - Country:US
Practice Address - Phone:310-441-0088
Practice Address - Fax:310-388-5809
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0405213ES0103X
CAE4339213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E4339Medicare ID - Type Unspecified
U90641Medicare UPIN
5419570001Medicare NSC