Provider Demographics
NPI:1508125592
Name:ESRAFIL ABEDI, MD
Entity Type:Organization
Organization Name:ESRAFIL ABEDI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESRAFIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-470-0600
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:#430
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-470-0600
Mailing Address - Fax:949-830-1096
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:#430
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-470-0600
Practice Address - Fax:949-830-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30818207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A308180Medicaid
CAA30818Medicare PIN