| Eshagh Ezra M.d., Inc. | |
|
15424 Nordhoff St Suite B North Hills CA 91343-6951 | |
| (818) 891-5500 | |
| (818) 891-5505 |
| Full Name | Eshagh Ezra M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 15424 Nordhoff St, North Hills, California |
| Authorized Official Name and Position | Eshagh Ezra (OWNER) |
| Authorized Official Contact | 8188915500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eshagh Ezra M.d., Inc. 22716 Paul Revere Dr Calabasas CA 91302-4812 Ph: (818) 891-5500 | Eshagh Ezra M.d., Inc. 15424 Nordhoff St Suite B North Hills CA 91343-6951 Ph: (818) 891-5500 |
| NPI Number | 1770698607 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0648210450 |
|---|---|
| Medicare Enrollment ID | O20050510001235 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770698607 | NPI | - | NPPES |
| 1790797835 | Other | CA | DR. EZRA'S PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A56249 (California) | Primary |
| Provider Name | Eshagh Ezra |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1790797835 PECOS PAC ID: 3971543794 Enrollment ID: I20050511000414 |
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