Provider Demographics
NPI:1225722465
Name:TALEBZADEH, ARJAVON TIN
Entity Type:Individual
Prefix:
First Name:ARJAVON
Middle Name:TIN
Last Name:TALEBZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ADMIRALTY CROSS
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3202
Mailing Address - Country:US
Mailing Address - Phone:619-948-3897
Mailing Address - Fax:
Practice Address - Street 1:9700 W TARON DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-8145
Practice Address - Country:US
Practice Address - Phone:916-686-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program