Provider Demographics
NPI:1700543253
Name:NAMAVARI, MEHRDAD
Entity type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:NAMAVARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 CAMINO DE VIDA APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2225
Mailing Address - Country:US
Mailing Address - Phone:805-453-5817
Mailing Address - Fax:
Practice Address - Street 1:192 CAMINO DE VIDA APT B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2225
Practice Address - Country:US
Practice Address - Phone:805-453-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19243171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist