Provider Demographics
NPI:1912161233
Name:GHAZAL, SANAZ (MD)
Entity Type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:GHAZAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BAJA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-7345
Mailing Address - Country:US
Mailing Address - Phone:617-947-7355
Mailing Address - Fax:
Practice Address - Street 1:1401 AVOCADO AVE STE 403
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8725
Practice Address - Country:US
Practice Address - Phone:949-706-2229
Practice Address - Fax:949-706-8490
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137587207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology