Provider Demographics
NPI:1881975761
Name:JOSEPH S. GHAZAL, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JOSEPH S. GHAZAL, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:GHAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-913-4303
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:STE 808
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-913-4303
Mailing Address - Fax:323-913-4361
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:STE 808
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-913-4303
Practice Address - Fax:323-913-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53712207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty