Provider Demographics
NPI:1093843799
Name:CRITICALCARE SPECIALIST INC.
Entity Type:Organization
Organization Name:CRITICALCARE SPECIALIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHARAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-914-9150
Mailing Address - Street 1:PO BOX 25373
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0373
Mailing Address - Country:US
Mailing Address - Phone:310-914-9150
Mailing Address - Fax:310-914-9705
Practice Address - Street 1:20911 EARL ST STE 180
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4353
Practice Address - Country:US
Practice Address - Phone:310-914-9150
Practice Address - Fax:310-914-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49504207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495041Medicaid
CA00A495041Medicaid
CAF11205Medicare UPIN