Provider Demographics
NPI:1295102887
Name:DAWOODIAN, ALEX (DPM)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:DAWOODIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19360 RINALDI ST STE 363
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1607
Mailing Address - Country:US
Mailing Address - Phone:866-895-8716
Mailing Address - Fax:818-475-1406
Practice Address - Street 1:903 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6755
Practice Address - Country:US
Practice Address - Phone:747-263-9696
Practice Address - Fax:818-475-1406
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE5428213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5428OtherLICENSE
CAE5428OtherLICENSE