1457304578 NPI number — DR. PARVINDOKHT SAFARI-KERMANSHAHI M.D.

Table of content: DR. PARVINDOKHT SAFARI-KERMANSHAHI M.D. (NPI 1457304578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457304578 NPI number — DR. PARVINDOKHT SAFARI-KERMANSHAHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAFARI-KERMANSHAHI
Provider First Name:
PARVINDOKHT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAFARI
Provider Other First Name:
PARVIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457304578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2238 THORNCROFT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551-6952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-265-0999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4002 VISTA WAY
Provider Second Line Business Practice Location Address:
TRI-CITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-940-3386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

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: 2080N0001X , with the licence number:  C43236 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080N0001X , with the licence number: 017080 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: H5620 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1355372 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".