Provider Demographics
NPI:1174508931
Name:TAHMOORESSI, PARVIZ (MD)
Entity Type:Individual
Prefix:MR
First Name:PARVIZ
Middle Name:
Last Name:TAHMOORESSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2893 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-5169
Mailing Address - Country:US
Mailing Address - Phone:530-722-0639
Mailing Address - Fax:
Practice Address - Street 1:351 HARTNELL AVE
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1845
Practice Address - Country:US
Practice Address - Phone:530-226-7526
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25163207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL405000Medicare ID - Type Unspecified