Provider Demographics
NPI:1902676695
Name:OHARA AIVAZ MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:OHARA AIVAZ MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AIVAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-285-0999
Mailing Address - Street 1:802 S SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4608
Mailing Address - Country:US
Mailing Address - Phone:310-940-3238
Mailing Address - Fax:
Practice Address - Street 1:400 S BEVERLY DR STE 380
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4424
Practice Address - Country:US
Practice Address - Phone:424-285-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty