Provider Demographics
NPI:1518942804
Name:FURUTAN, NAVID PARVIZ (MD)
Entity Type:Individual
Prefix:
First Name:NAVID
Middle Name:PARVIZ
Last Name:FURUTAN
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 1:21634 RETREAT PKWY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6100
Mailing Address - Country:US
Mailing Address - Phone:951-493-6830
Mailing Address - Fax:951-272-2813
Practice Address - Street 1:21634 RETREAT PKWY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-6100
Practice Address - Country:US
Practice Address - Phone:951-493-6830
Practice Address - Fax:951-272-2813
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85917208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31887ZOtherSITE LOCATION NUMBER
F73970Medicare UPIN
OOG859170Medicare ID - Type Unspecified