Provider Demographics
NPI:1427210764
Name:SAFAVI, HALEH
Entity type:Individual
Prefix:MRS
First Name:HALEH
Middle Name:
Last Name:SAFAVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE
Mailing Address - Street 2:610
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4300
Mailing Address - Country:US
Mailing Address - Phone:714-285-2311
Mailing Address - Fax:
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:610
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4300
Practice Address - Country:US
Practice Address - Phone:714-285-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine