Provider Demographics
NPI:1396874764
Name:PARVIZ SALEHI, MD, INC.
Entity type:Organization
Organization Name:PARVIZ SALEHI, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARVIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-343-5109
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-1026
Mailing Address - Country:US
Mailing Address - Phone:818-343-5109
Mailing Address - Fax:818-343-8770
Practice Address - Street 1:6648 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5313
Practice Address - Country:US
Practice Address - Phone:818-343-5109
Practice Address - Fax:818-343-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39866302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39866OtherMEDICAL LIC. NO.
CAH65842Medicare UPIN