Provider Demographics
NPI:1760493076
Name:DELSHAD, GEORGE MORDECHAI (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MORDECHAI
Last Name:DELSHAD
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:PO BOX 16189
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6189
Mailing Address - Country:US
Mailing Address - Phone:310-463-8391
Mailing Address - Fax:818-899-5969
Practice Address - Street 1:15211 VANOWEN ST STE 310
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3615
Practice Address - Country:US
Practice Address - Phone:310-463-8381
Practice Address - Fax:818-830-3015
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83566207V00000X
CAG083566207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G835660Medicaid
CA00G835660Medicaid
G38551Medicare UPIN