Provider Demographics
NPI:1467583138
Name:BABAZADEH, SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:BABAZADEH
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 1:3340 W BALL RD STE I
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3729
Mailing Address - Country:US
Mailing Address - Phone:714-827-3911
Mailing Address - Fax:714-906-5521
Practice Address - Street 1:3340 W BALL RD STE I
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3729
Practice Address - Country:US
Practice Address - Phone:714-827-3911
Practice Address - Fax:714-906-5521
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146M00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84586Medicare UPIN