Provider Demographics
NPI:1396906921
Name:FERZLI, PASCAL (MD)
Entity type:Individual
Prefix:DR
First Name:PASCAL
Middle Name:
Last Name:FERZLI
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 1:18782 ROXBURY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6858
Mailing Address - Country:US
Mailing Address - Phone:617-947-3626
Mailing Address - Fax:
Practice Address - Street 1:500 PACIFIC COAST HWY STE 212
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6643
Practice Address - Country:US
Practice Address - Phone:562-431-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125157207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30208900Medicaid
NH30208900Medicaid