Provider Demographics
NPI:1952634826
Name:LOIZIDES, PHOTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PHOTIS
Middle Name:
Last Name:LOIZIDES
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 1:2302 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2712
Mailing Address - Country:US
Mailing Address - Phone:323-691-4105
Mailing Address - Fax:323-442-7901
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:ROOM 514
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-7903
Practice Address - Fax:323-442-7901
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109369208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery