Provider Demographics
NPI:1861845273
Name:BORDBAR, VAHID
Entity Type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:BORDBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 PALOS VERDES DR W STE 220
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2777
Mailing Address - Country:US
Mailing Address - Phone:424-327-2990
Mailing Address - Fax:424-327-2996
Practice Address - Street 1:2325 PALOS VERDES DR W STE 220
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2777
Practice Address - Country:US
Practice Address - Phone:424-327-2990
Practice Address - Fax:424-327-2996
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450861835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy