Provider Demographics
NPI:1457304578
Name:SAFARI-KERMANSHAHI, PARVINDOKHT (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVINDOKHT
Middle Name:
Last Name:SAFARI-KERMANSHAHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PARVIN
Other - Middle Name:
Other - Last Name:SAFARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2238 THORNCROFT CIR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6952
Mailing Address - Country:US
Mailing Address - Phone:661-265-0999
Mailing Address - Fax:
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:TRI-CITY MEDICAL CENTER
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4506
Practice Address - Country:US
Practice Address - Phone:760-940-3386
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC432362080N0001X
LA0170802080N0001X
TXH56202080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355372Medicaid
TXF63793Medicare UPIN