Provider Demographics
NPI:1649280272
Name:EFTEKHARI, HESSAM S (DO)
Entity type:Individual
Prefix:DR
First Name:HESSAM
Middle Name:S
Last Name:EFTEKHARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31371 RANCHO VIEJO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1848
Mailing Address - Country:US
Mailing Address - Phone:949-565-0444
Mailing Address - Fax:949-565-0446
Practice Address - Street 1:31371 RANCHO VIEJO RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1848
Practice Address - Country:US
Practice Address - Phone:949-565-0444
Practice Address - Fax:949-565-0446
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9311207L00000X, 208U00000X, 2084P2900X, 207LA0401X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX93110Medicaid
CA020A93110Medicare PIN
CAI64135Medicare UPIN
CA20A9311Medicare PIN