# RENAISSANCE ASTHETIC LASER AND VEIN INSTITUTE, A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730258187
- **Authorized official:** GHOLAM REZA MOHAMMADZADEH MD (OWNER/PRESIDENT)
- **Authorized official phone:** (805) 379-6717

## Contact information

- **Practice address:** 77 ROLLING OAKS DR STE 202, THOUSAND OAKS, CA 91361-1018
- **Practice address phone:** (805) 379-6717
- **Mailing address:** 77 ROLLING OAKS DR STE 202, THOUSAND OAKS, CA 91361-1018
- **Mailing address phone:** (805) 379-6717
- **Mailing address fax:** (805) 379-6719

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 08/23/2024