Provider Demographics
NPI:1356501084
Name:JAFARIMOJARRAD, ELHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:JAFARIMOJARRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELHAM
Other - Middle Name:
Other - Last Name:JAFARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7894
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-7894
Mailing Address - Country:US
Mailing Address - Phone:949-793-3376
Mailing Address - Fax:949-335-9809
Practice Address - Street 1:18 ENDEAVOR
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3164
Practice Address - Country:US
Practice Address - Phone:949-793-3376
Practice Address - Fax:949-335-9809
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA971602084N0008X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI809TMedicare PIN
CACI809XMedicare PIN
CACI809ZMedicare PIN
CACI809UMedicare PIN
CACI809YMedicare PIN
CACI809WMedicare PIN
CACI809VMedicare PIN