Provider Demographics
NPI:1861431314
Name:OURMAZDI, BEHZAD (MD)
Entity type:Individual
Prefix:DR
First Name:BEHZAD
Middle Name:
Last Name:OURMAZDI
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 1:4000 CALLE TECATE
Mailing Address - Street 2:112
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5284
Mailing Address - Country:US
Mailing Address - Phone:805-383-2929
Mailing Address - Fax:805-383-2932
Practice Address - Street 1:4000 CALLE TECATE
Practice Address - Street 2:112
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5284
Practice Address - Country:US
Practice Address - Phone:805-383-2929
Practice Address - Fax:805-383-2932
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68976204D00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH39889Medicare UPIN
CAWA68976BMedicare PIN