Provider Demographics
NPI:1275564775
Name:TAHERI, PARVIZ P (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVIZ
Middle Name:P
Last Name:TAHERI
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 1:13680 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3616
Mailing Address - Country:US
Mailing Address - Phone:818-897-7730
Mailing Address - Fax:818-897-7831
Practice Address - Street 1:13680 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3616
Practice Address - Country:US
Practice Address - Phone:818-897-7730
Practice Address - Fax:818-897-7831
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB90500Medicare UPIN