Provider Demographics
NPI:1073884474
Name:DR ALIREZA PESSARAN MD INC
Entity Type:Organization
Organization Name:DR ALIREZA PESSARAN MD INC
Other - Org Name:CAPITAL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:PESSARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-489-3641
Mailing Address - Street 1:6437 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4021
Mailing Address - Country:US
Mailing Address - Phone:916-489-3641
Mailing Address - Fax:916-489-2770
Practice Address - Street 1:6437 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4021
Practice Address - Country:US
Practice Address - Phone:916-489-3641
Practice Address - Fax:916-489-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGNB32009-43470173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty