Provider Demographics
NPI:1255011672
Name:EDWIN AMIRIANFAR DO PSC
Entity type:Organization
Organization Name:EDWIN AMIRIANFAR DO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRIANFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-666-2320
Mailing Address - Street 1:200 W LIBERTY ST STE 1809
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2473
Mailing Address - Country:US
Mailing Address - Phone:310-666-2320
Mailing Address - Fax:
Practice Address - Street 1:200 W LIBERTY ST STE 1809
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2473
Practice Address - Country:US
Practice Address - Phone:310-666-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty