Basic Information
Provider Information | |||||||||
NPI: | 1154788289 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MULTI-SPECIALTY HEALTHCARE MANAGEMENT SERVICES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 16952 VENTURA BLVD STE 100-A | ||||||||
Address2: |   | ||||||||
City: | ENCINO | ||||||||
State: | CA | ||||||||
PostalCode: | 913164197 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8187893964 | ||||||||
FaxNumber: | 8187893967 | ||||||||
Practice Location | |||||||||
Address1: | 16952 VENTURA BLVD STE 100-A | ||||||||
Address2: |   | ||||||||
City: | ENCINO | ||||||||
State: | CA | ||||||||
PostalCode: | 913164197 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8187893964 | ||||||||
FaxNumber: | 8187893967 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/20/2016 | ||||||||
LastUpdateDate: | 05/11/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SHIRAZY | ||||||||
AuthorizedOfficialFirstName: | PEJMAN | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 8187893964 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 583427 | CA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
ID | Type | State | Issuer | Description | 583427 | 01 | CA | JACHO ORGANIZATION IDENTIFICATION NUMBER | OTHER |