Provider Demographics
NPI:1023101458
Name:MEHDIZADEH, PEGAH (DO)
Entity type:Individual
Prefix:
First Name:PEGAH
Middle Name:
Last Name:MEHDIZADEH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 PASEO PRIMARIO
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3057
Mailing Address - Country:US
Mailing Address - Phone:818-922-5204
Mailing Address - Fax:
Practice Address - Street 1:3809 PASEO PRIMARIO
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3057
Practice Address - Country:US
Practice Address - Phone:818-922-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine