Provider Demographics
NPI:1477608552
Name:ESFANDIARI, SEIFOLAH (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:SEIFOLAH
Middle Name:
Last Name:ESFANDIARI
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N TUSTIN AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6504
Mailing Address - Country:US
Mailing Address - Phone:714-953-1112
Mailing Address - Fax:714-547-5792
Practice Address - Street 1:999 N TUSTIN AVE STE 111
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6504
Practice Address - Country:US
Practice Address - Phone:714-953-1112
Practice Address - Fax:714-547-5792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C396530Medicaid
CAC39653Medicare PIN
CAA89087Medicare UPIN