1861722134 NPI number — DR. JONES HORMOZI DPM

Table of content: DR. JONES HORMOZI DPM (NPI 1861722134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861722134 NPI number — DR. JONES HORMOZI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORMOZI
Provider First Name:
JONES
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861722134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17412 VENTURA BLVD STE 31
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-3827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-981-1900
Provider Business Mailing Address Fax Number:
866-254-5997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18840 VENTURA BLVD STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-981-1900
Provider Business Practice Location Address Fax Number:
866-254-5997
Provider Enumeration Date:
01/08/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E 4856 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)