Provider Demographics
NPI:1477945228
Name:ROKHSAREH TAJRISHI INC.
Entity Type:Organization
Organization Name:ROKHSAREH TAJRISHI INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROKHSAREH
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:TAJRISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-478-2088
Mailing Address - Street 1:3334 E COAST HWY
Mailing Address - Street 2:SUITE 570
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2328
Mailing Address - Country:US
Mailing Address - Phone:714-903-7767
Mailing Address - Fax:714-903-7801
Practice Address - Street 1:3334 E COAST HWY
Practice Address - Street 2:SUITE 570
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2328
Practice Address - Country:US
Practice Address - Phone:714-903-7767
Practice Address - Fax:714-903-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133047207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164701819OtherNPPES