Provider Demographics
NPI:1558391342
Name:SANI, JAVAD NAJAFI (MD)
Entity Type:Individual
Prefix:
First Name:JAVAD
Middle Name:NAJAFI
Last Name:SANI
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 1:1315 LAS TABLAS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9759
Mailing Address - Country:US
Mailing Address - Phone:805-434-2533
Mailing Address - Fax:805-434-3037
Practice Address - Street 1:1315 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9759
Practice Address - Country:US
Practice Address - Phone:805-434-2533
Practice Address - Fax:805-434-3037
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A334220Medicaid
CA00A334220Medicaid
CAWA33422AMedicare ID - Type Unspecified