Provider Demographics
NPI:1629827084
Name:PANTEA PAHLAVAN, MD
Entity type:Organization
Organization Name:PANTEA PAHLAVAN, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANTEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-325-9805
Mailing Address - Street 1:5140 BUSINESS CENTER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1794
Mailing Address - Country:US
Mailing Address - Phone:510-325-9805
Mailing Address - Fax:
Practice Address - Street 1:5140 BUSINESS CENTER DR STE 13
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1793
Practice Address - Country:US
Practice Address - Phone:707-736-6900
Practice Address - Fax:707-931-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty