1689982365 NPI number — ARASH AFARI PROFESSIONAL MED CORP

Table of content: (NPI 1689982365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689982365 NPI number — ARASH AFARI PROFESSIONAL MED CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARASH AFARI PROFESSIONAL MED CORP
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:
6
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:
1689982365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2355 WESTWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 259
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90064-2109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-626-8315
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 CENTURY PARK E
Provider Second Line Business Practice Location Address:
SUITE 1410
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90067-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-626-8315
Provider Business Practice Location Address Fax Number:
800-650-0615
Provider Enumeration Date:
09/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AFARI
Authorized Official First Name:
ARASH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
800-626-8315

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  A97866 , 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)

  • Identifier: 9271152 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A978660 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ53210Y . This is a "BLUESHIELD/TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1982861852 . This is a "CALIFORNIA'S VALUED TRUST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ53210Y . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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