Provider Demographics
NPI:1669547618
Name:BARARSANI, MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:BARARSANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-920-9666
Mailing Address - Fax:310-379-6360
Practice Address - Street 1:18051 CRENSHAW BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5127
Practice Address - Country:US
Practice Address - Phone:310-715-2323
Practice Address - Fax:310-715-6020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35392305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00A353920Medicaid
MI00A353920Medicaid
CAWA35392Medicare ID - Type Unspecified