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

Table of content: JACQUELINE PRISCILLA GREEN CRNP (NPI 1306348487)

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)





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