Provider Demographics
NPI: | 1679176754 |
---|---|
Name: | TAHER SAIFULLAH MD A PROFESSIONAL MEDICAL CORPORATION |
Entity Type: | Organization |
Organization Name: | TAHER SAIFULLAH MD A PROFESSIONAL MEDICAL CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TAHER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SAIFULLAH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 909-524-1041 |
Mailing Address - Street 1: | 801 S OLIVE ST APT 1806 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90014-3029 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 625 S FAIR OAKS AVE STE 230 |
Practice Address - Street 2: | |
Practice Address - City: | PASADENA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91105-2663 |
Practice Address - Country: | US |
Practice Address - Phone: | 626-469-2939 |
Practice Address - Fax: | 626-469-2956 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-11-19 |
Last Update Date: | 2021-02-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Single Specialty |