Provider Demographics
NPI:1295967297
Name:CASPIAN MEDICAL CLINIC CORP
Entity type:Organization
Organization Name:CASPIAN MEDICAL CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFARANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:818-994-0000
Mailing Address - Street 1:14103 VICTORY BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1998
Mailing Address - Country:US
Mailing Address - Phone:818-994-0000
Mailing Address - Fax:
Practice Address - Street 1:14103 VICTORY BLVD STE 7
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1998
Practice Address - Country:US
Practice Address - Phone:818-994-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0492352080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty