Provider Demographics
NPI:1427021583
Name:PAHLAVAN, PANTEA (MD)
Entity Type:Individual
Prefix:
First Name:PANTEA
Middle Name:
Last Name:PAHLAVAN
Suffix:
Gender:F
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:FILE 74501
Mailing Address - Street 2:PO BOX 60000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:707-438-7600
Mailing Address - Fax:707-429-8604
Practice Address - Street 1:1860 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 300A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3590
Practice Address - Country:US
Practice Address - Phone:707-438-7600
Practice Address - Fax:707-429-8604
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77685207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A776850Medicaid
CA00A776850Medicaid
CAH96450Medicare UPIN