Provider Demographics
NPI:1083952337
Name:UNIVERSITY BARIATRICS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:UNIVERSITY BARIATRICS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-379-9796
Mailing Address - Street 1:23679 CALABASAS RD
Mailing Address - Street 2:SUITE 1072
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1502
Mailing Address - Country:US
Mailing Address - Phone:805-379-9796
Mailing Address - Fax:805-379-6700
Practice Address - Street 1:425 HAALAND DR
Practice Address - Street 2:#203
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5229
Practice Address - Country:US
Practice Address - Phone:805-379-9796
Practice Address - Fax:805-379-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68045208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty