Provider Demographics
NPI:1932518362
Name:ISSAVI, HORMOZ (MD)
Entity Type:Individual
Prefix:
First Name:HORMOZ
Middle Name:
Last Name:ISSAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HORMOZ
Other - Middle Name:
Other - Last Name:ISSAVI DIZAJTAKIEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4601 DALE RD
Mailing Address - Street 2:4TH FLOOR, STE 4A8
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9718
Mailing Address - Country:US
Mailing Address - Phone:209-735-5000
Mailing Address - Fax:
Practice Address - Street 1:315 MERCY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8363
Practice Address - Country:US
Practice Address - Phone:209-564-3500
Practice Address - Fax:209-564-3598
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine