Provider Demographics
NPI:1205851599
Name:SHARIFI, PANTEA (MD)
Entity Type:Individual
Prefix:
First Name:PANTEA
Middle Name:
Last Name:SHARIFI
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 1:3524 TORRANCE BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4821
Mailing Address - Country:US
Mailing Address - Phone:310-540-1630
Mailing Address - Fax:310-543-0400
Practice Address - Street 1:3524 TORRANCE BLVD
Practice Address - Street 2:STE 103
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4821
Practice Address - Country:US
Practice Address - Phone:310-540-1630
Practice Address - Fax:310-543-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA786242080P0008X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205851599Medicaid
CA1205851599Medicaid