Provider Demographics
NPI:1477652410
Name:PARSA, A THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:A THOMAS
Middle Name:
Last Name:PARSA
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 1:2864 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6714
Mailing Address - Country:US
Mailing Address - Phone:714-996-9708
Mailing Address - Fax:714-996-1230
Practice Address - Street 1:2864 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6714
Practice Address - Country:US
Practice Address - Phone:714-996-9708
Practice Address - Fax:714-996-1230
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330607300OtherTAX ID
CA00A559140Medicaid
CA00A559140Medicaid
CA330607300OtherTAX ID