Provider Demographics
NPI:1063622181
Name:GHODSIAN, MAZIAR (DO)
Entity type:Individual
Prefix:DR
First Name:MAZIAR
Middle Name:
Last Name:GHODSIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4808
Mailing Address - Country:US
Mailing Address - Phone:800-280-6384
Mailing Address - Fax:949-666-6555
Practice Address - Street 1:300 S BEVERLY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4808
Practice Address - Country:US
Practice Address - Phone:800-280-6384
Practice Address - Fax:949-666-6555
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9722208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery