1528332905 NPI number — PANTEA SHARIFI HANNAUER, M.D. INC.

Table of content: (NPI 1528332905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528332905 NPI number — PANTEA SHARIFI HANNAUER, M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANTEA SHARIFI HANNAUER, M.D. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528332905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4269
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90510-4269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-540-1630
Provider Business Mailing Address Fax Number:
310-540-1610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3524 TORRANCE BLVD.,
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-540-1630
Provider Business Practice Location Address Fax Number:
310-540-1610
Provider Enumeration Date:
03/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SHARIFI HANNAUER
Authorized Official First Name:
PANTEA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-540-1630

Provider Taxonomy Codes

  • Taxonomy code: 2080P0008X , with the licence number:  A78624 , 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)





Copyright © 2007-2025 www.npivalidator.com