Provider Demographics
NPI:1871542985
Name:KHORVASH, PIRUZ BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:PIRUZ
Middle Name:BRUCE
Last Name:KHORVASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PIROOZ
Other - Middle Name:BRUCE
Other - Last Name:KHORVASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7624 REPOSADO DR.
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7928
Mailing Address - Country:US
Mailing Address - Phone:760-942-9950
Mailing Address - Fax:760-942-9950
Practice Address - Street 1:7624 REPOSADO DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7928
Practice Address - Country:US
Practice Address - Phone:760-942-9950
Practice Address - Fax:760-942-9950
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0856205208000000X
CA05D0856202080A0000X
CAA26424208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05170360080OtherMEDICAL EDUCATION #
CA00A2642408Medicaid
031805Medicare PIN
E73576Medicare UPIN