Provider Demographics
NPI:1457829558
Name:AVID MEDICAL
Entity Type:Organization
Organization Name:AVID MEDICAL
Other - Org Name:AVID MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABRIZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-884-4855
Mailing Address - Street 1:1220 HEMLOCK WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3655
Mailing Address - Country:US
Mailing Address - Phone:714-884-4855
Mailing Address - Fax:714-834-1076
Practice Address - Street 1:1220 HEMLOCK WAY STE 205
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3655
Practice Address - Country:US
Practice Address - Phone:714-884-4855
Practice Address - Fax:714-834-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty