Organization
RENAISSANCE ASTHETIC LASER AND VEIN INSTITUTE, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHOLAM REZA MOHAMMADZADEH MD (OWNER/PRESIDENT)
(805) 379-6717
Entity
Organization
Contact information
Practice address
77 ROLLING OAKS DR STE 202, THOUSAND OAKS, CA 91361-1018
(805) 379-6717
Mailing address
77 ROLLING OAKS DR STE 202, THOUSAND OAKS, CA 91361-1018
(805) 379-6717
(805) 379-6719
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
11/07/2006
Last updated
08/23/2024
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