Provider Demographics
NPI:1528181005
Name:PARVIN SHAFA M D INC
Entity Type:Organization
Organization Name:PARVIN SHAFA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-551-1113
Mailing Address - Street 1:113 WATERWORKS WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3171
Mailing Address - Country:US
Mailing Address - Phone:949-551-1113
Mailing Address - Fax:949-551-1103
Practice Address - Street 1:113 WATERWORKS WAY STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3171
Practice Address - Country:US
Practice Address - Phone:949-551-1113
Practice Address - Fax:949-551-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty