Provider Demographics
NPI:1568497998
Name:TABRIZI, PELMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PELMA
Middle Name:
Last Name:TABRIZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HEMLOCK WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3655
Mailing Address - Country:US
Mailing Address - Phone:714-884-4855
Mailing Address - Fax:714-834-1076
Practice Address - Street 1:1220 HEMLOCK WAY STE 205
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3655
Practice Address - Country:US
Practice Address - Phone:714-884-4855
Practice Address - Fax:714-834-1076
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A829360Medicaid
572-192-3OtherECFMG NUMBER
BT8519716OtherDEA NUMBER
AZZ200162Medicare PIN
CA00A829360Medicaid