Provider Demographics
NPI:1942230495
Name:AMINI, PARVIZ (MD)
Entity Type:Individual
Prefix:MR
First Name:PARVIZ
Middle Name:
Last Name:AMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4625
Mailing Address - Country:US
Mailing Address - Phone:818-998-6008
Mailing Address - Fax:818-998-6003
Practice Address - Street 1:8435 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4625
Practice Address - Country:US
Practice Address - Phone:818-998-6000
Practice Address - Fax:818-998-6003
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487400Medicaid
CA00A487400Medicaid
CAA48470Medicare ID - Type Unspecified