Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | A66439 | CA |
NPI | 1083787980 |
---|---|
Provider Name | Ghassan Kazmouz |
First Address | Palm Desert, CA 92255 |
Second Address | Palm Springs, CA 92262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 20/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A664390 | (05) | CA |
A66439 | MEDICAL LICENSE (01) | CA |
BK6106036 | DEA (01) | CA |