1194261073 NPI number — MR. BEHRANG VAMEGHI VESSALI PHYSICIAN ASSISTANT

Table of content: MR. BEHRANG VAMEGHI VESSALI PHYSICIAN ASSISTANT (NPI 1194261073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194261073 NPI number — MR. BEHRANG VAMEGHI VESSALI PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VESSALI
Provider First Name:
BEHRANG
Provider Middle Name:
VAMEGHI
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VESSALI
Provider Other First Name:
BEHRANG
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICIAN ASSISTANT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194261073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12922 VICTORY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91606-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-760-2800
Provider Business Mailing Address Fax Number:
818-760-9730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12922 VICTORY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-760-2800
Provider Business Practice Location Address Fax Number:
818-760-9730
Provider Enumeration Date:
01/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  54074 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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