Provider Demographics
NPI:1487659637
Name:ESLAMI FARSANI, MAHMOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:ESLAMI FARSANI
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 1:700 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3508
Mailing Address - Country:US
Mailing Address - Phone:714-245-1444
Mailing Address - Fax:714-953-6604
Practice Address - Street 1:700 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3508
Practice Address - Country:US
Practice Address - Phone:714-245-1444
Practice Address - Fax:714-953-6604
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62348174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB3373OtherRAILROAD MEDICARE
CAW13988AOtherMEDICARE PTAN
CAW13988OtherMEDICARE PTAN
CAP00074100OtherRAILROAD MEDICARE
CA00A623480Medicaid
CAW13988AOtherMEDICARE PTAN
CAHW13988AMedicare PIN
CAP00074100OtherRAILROAD MEDICARE
CA00A623480Medicaid
CAW13988OtherMEDICARE PTAN
CAHW13988Medicare PIN