Provider Demographics
NPI:1326236126
Name:E. ESFANDIARIFARD M.D. INC.
Entity Type:Organization
Organization Name:E. ESFANDIARIFARD M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ESFANDIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ESFANDIARIFARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-4030
Mailing Address - Street 1:16661 VENTURA BLVD STE 515
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1972
Mailing Address - Country:US
Mailing Address - Phone:818-990-4030
Mailing Address - Fax:818-990-4031
Practice Address - Street 1:16661 VENTURA BLVD STE 515
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1972
Practice Address - Country:US
Practice Address - Phone:818-990-4030
Practice Address - Fax:818-990-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-06
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A740460Medicaid
CA00A740460Medicaid
CAW16066Medicare PIN