Provider Demographics
NPI:1346545142
Name:SAMIMI, SIAVASH AZADMANESH
Entity Type:Individual
Prefix:
First Name:SIAVASH
Middle Name:AZADMANESH
Last Name:SAMIMI
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 1:183 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2341
Mailing Address - Country:US
Mailing Address - Phone:530-891-6244
Mailing Address - Fax:
Practice Address - Street 1:183 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2341
Practice Address - Country:US
Practice Address - Phone:530-891-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA135924207ZC0500X, 207ZP0102X
NMMD2019-0725207ZC0500X, 207ZP0102X
CA390200000X
NY321389207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program