Provider Demographics
NPI:1639130933
Name:BAVAFA, SHARIAR Z (MD)
Entity Type:Individual
Prefix:
First Name:SHARIAR
Middle Name:Z
Last Name:BAVAFA
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:3020 OLD RANCH PARKWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:562-799-5518
Mailing Address - Fax:562-799-5544
Practice Address - Street 1:3020 OLD RANCH PARKWAY
Practice Address - Street 2:3RD FLOOR STERLING PATHOLOGY LABORATORY
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:562-799-5518
Practice Address - Fax:562-799-5544
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA43169207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A431690Medicaid
CA00A431690Medicaid
CAD38228Medicare UPIN