Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A135378 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A135378 | CA |
N | 207NS0135X | Procedural Dermatology | A135378 | CA |
NPI | 1104110071 |
---|---|
Provider Name | Dr. Navid Ezra |
First Address | Thousand Oaks, CA 91320-2130 |
Second Address | Thousand Oaks, CA 91320-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 14/10/2020 |