Provider Demographics
NPI:1760451751
Name:FIROZBAKHT, PARVANEH (PA)
Entity Type:Individual
Prefix:
First Name:PARVANEH
Middle Name:
Last Name:FIROZBAKHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6505
Mailing Address - Country:US
Mailing Address - Phone:817-966-6222
Mailing Address - Fax:
Practice Address - Street 1:2100 SOLAR DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2661
Practice Address - Country:US
Practice Address - Phone:805-988-9000
Practice Address - Fax:805-988-9089
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03421363A00000X
CA57682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187725003Medicaid
TX818N24OtherBCBS
TX187725001Medicaid
TX187725003Medicaid
TX187725001Medicaid
TXQ16939Medicare UPIN
TX8J6812Medicare PIN