Provider Demographics
NPI:1982636122
Name:MINAZAD, YAFA (DO)
Entity Type:Individual
Prefix:DR
First Name:YAFA
Middle Name:
Last Name:MINAZAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2613
Mailing Address - Country:US
Mailing Address - Phone:626-535-9344
Mailing Address - Fax:626-535-9387
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-535-9344
Practice Address - Fax:626-535-9387
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO19412084N0400X
CA20A79742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX79740Medicaid
CAW20A7974AMedicare PIN
CA00AX79740Medicaid