Provider Demographics
NPI:1316098841
Name:PAYA, MAHBOD (MD)
Entity type:Individual
Prefix:
First Name:MAHBOD
Middle Name:
Last Name:PAYA
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 1:7320 WOODLAKE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1468
Mailing Address - Country:US
Mailing Address - Phone:818-888-7090
Mailing Address - Fax:818-888-0448
Practice Address - Street 1:7320 WOODLAKE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1468
Practice Address - Country:US
Practice Address - Phone:818-888-7090
Practice Address - Fax:818-888-0448
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77354208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA77354Medicare ID - Type Unspecified
CAH93615Medicare UPIN