Provider Demographics
NPI:1326452418
Name:TAFAZOLI, SHARWIN (MD)
Entity Type:Individual
Prefix:
First Name:SHARWIN
Middle Name:
Last Name:TAFAZOLI
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 1:1819 WASHINGTON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3324
Mailing Address - Country:US
Mailing Address - Phone:310-382-0233
Mailing Address - Fax:
Practice Address - Street 1:1819 WASHINGTON AVE APT A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-3324
Practice Address - Country:US
Practice Address - Phone:310-382-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139135208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation