Individual
REZA RAY EHSAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
(310) 390-9551
(310) 390-9296
Mailing address
11600 VENICE BLVD, LOS ANGELES, CA 90066-4014
(310) 390-9551
(310) 390-9296
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
A50372
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
A50372
CA
207Q00000X
Family Medicine Physician
A50372
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467537480
—
CA
Enumeration date
10/26/2006
Last updated
01/05/2016
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