Provider Demographics
NPI:1134202849
Name:JESSANI, PARVEZ P (MD)
Entity type:Individual
Prefix:
First Name:PARVEZ
Middle Name:P
Last Name:JESSANI
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 1:104 WANDERER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0885
Mailing Address - Country:US
Mailing Address - Phone:520-977-2372
Mailing Address - Fax:
Practice Address - Street 1:104 WANDERER
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0885
Practice Address - Country:US
Practice Address - Phone:520-977-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22709207R00000X
CAC131631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ191263Medicaid
AZ191263Medicaid
23772Medicare ID - Type Unspecified