Provider Demographics
NPI:1912941808
Name:PARSA, SHAHRAM (MD)
Entity Type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:
Last Name:PARSA
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 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4302
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:44216 N. 10TH W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4134
Practice Address - Country:US
Practice Address - Phone:661-273-8813
Practice Address - Fax:661-273-2105
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A794970Medicaid
CA00A794970OtherMEDI CAL
CABU116ZMedicare PIN
CAWA79497BMedicare PIN
CA00A794970Medicaid
CA00A794970OtherMEDI CAL