Provider Demographics
NPI:1154380574
Name:CORDES, SANAZ (MD)
Entity type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:CORDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANAZ
Other - Middle Name:
Other - Last Name:MEHDIZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1172 N. MACLAY AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340
Mailing Address - Country:US
Mailing Address - Phone:818-898-1388
Mailing Address - Fax:818-365-4031
Practice Address - Street 1:7138 VAN NUYS BLVD.
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-778-6240
Practice Address - Fax:818-994-8005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00981Medicare UPIN