Provider Demographics
NPI:1174629166
Name:JAFARI, GOLRIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:GOLRIZ
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 MALCOLM AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6835
Mailing Address - Country:US
Mailing Address - Phone:310-948-1360
Mailing Address - Fax:
Practice Address - Street 1:101 E BEVERLY BLVD STE 304
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4316
Practice Address - Country:US
Practice Address - Phone:323-722-7418
Practice Address - Fax:323-722-7894
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70146207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH94125Medicare UPIN