| Doctor Name: | MR. KAMBIZ IZADSETA |
| NPI Number: | 1386016202 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | A019230615 |
| Business Practice Address: | 7885 Annandale Ave Desert Hot Springs, CA - 922401419 |
| Business Phone Number: | 7603292925 |
| Business Fax Number: | 7603290169 |
| Mailing Address: | 7885 Annandale Ave, DESERT HOT SPRINGS |
| State: | CA |
| Postal Code: | 922401419 |
| Phone Number: | 7603292925 |
| Fax Number: | 7603290169 |
| NPI Enumeration Date: | 10/30/2015 |
| NPI Last Update Date: | 10/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | A019230615 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |