Provider Demographics
NPI:1215950647
Name:DZHANASHVILI, RAMAZ (MD)
Entity type:Individual
Prefix:
First Name:RAMAZ
Middle Name:
Last Name:DZHANASHVILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17777 VENTURA BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3717
Mailing Address - Country:US
Mailing Address - Phone:818-654-8311
Mailing Address - Fax:818-654-8382
Practice Address - Street 1:17777 VENTURA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3717
Practice Address - Country:US
Practice Address - Phone:818-654-8311
Practice Address - Fax:818-654-8382
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45389173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453890Medicaid
CAA45389AMedicare PIN
CA00A453890Medicaid