Provider Information for 1194023994
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AFSHEEN IZADI
Other Names:Other Name:BRUCE IZADISex: Male
NPI: 1194023994
Last Updated: 2023-09-22
Certification Date: 2023-09-22
Certification Date: 2023-09-22
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1194023994 | ||||||||
| Enumeration Date | 2011-03-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 32297 BIG OAK LN CASTAIC, CA 91384-4124 United States Phone: 626-277-1307 | Fax: | ||||||||
| Primary Practice Address | 9517 REA AVE CALIFORNIA CITY, CA 93505-4831 United States Phone: 626-277-1307 | Fax: | ||||||||
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