Provider Demographics
NPI:1235186347
Name:JAFARI, ALIREZA (MD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:JAFARI
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 1:10053 WHITTWOOD DR UNIT 1218
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90609-0412
Mailing Address - Country:US
Mailing Address - Phone:562-696-9265
Mailing Address - Fax:877-887-8750
Practice Address - Street 1:14350 WHITTIER BLVD STE 310
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2152
Practice Address - Country:US
Practice Address - Phone:562-945-7746
Practice Address - Fax:562-945-6619
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49135207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A491350Medicaid
CAA49135Medicare ID - Type Unspecified
CA00A491350Medicaid