Provider Demographics
NPI:1356482392
Name:TABESH, ALIREZA (MD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:TABESH
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:PO BOX 51741
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-6041
Mailing Address - Country:US
Mailing Address - Phone:323-987-1362
Mailing Address - Fax:323-987-1380
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2488
Practice Address - Country:US
Practice Address - Phone:323-987-1301
Practice Address - Fax:323-987-1380
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104245207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology