Provider Demographics
NPI:1295791853
Name:MOHAMADI, PARIVASH (MD)
Entity type:Individual
Prefix:
First Name:PARIVASH
Middle Name:
Last Name:MOHAMADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 TORRANCE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4405
Mailing Address - Country:US
Mailing Address - Phone:310-370-5694
Mailing Address - Fax:310-214-6671
Practice Address - Street 1:4305 TORRANCE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4405
Practice Address - Country:US
Practice Address - Phone:310-370-5694
Practice Address - Fax:310-214-6671
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43089208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A430890Medicaid
CAA43089BMedicare ID - Type Unspecified
CA00A430890Medicaid