Provider Demographics
NPI:1265295208
Name:KOHZADI, ERFAN
Entity type:Individual
Prefix:
First Name:ERFAN
Middle Name:
Last Name:KOHZADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EL CERRITO DR APT 5
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6072
Mailing Address - Country:US
Mailing Address - Phone:323-275-7064
Mailing Address - Fax:
Practice Address - Street 1:800 EL CERRITO DR APT 5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6072
Practice Address - Country:US
Practice Address - Phone:323-275-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist