MEDICARE: DR. ARDAVAN AFRASIABI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L5215	TX
2	207R00000X	Internal Medicine Physician	C52848	CA

General Provider Information

NPI Number	:	1295722726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARDAVAN AFRASIABI MD

Provider Business Mailing Address
First Line	:	1092 LA LIMONAR RD
Second Line	:
City	:	NORTH TUSTIN
State	:	CA
Zip	:	92705-2304
Country	:	US
Telephone Number	:	714-734-0679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1092 LA LIMONAR RD
Second Line	:
City	:	NORTH TUSTIN
State	:	CA
Zip	:	92705-2304
Country	:	US
Telephone Number	:	714-734-0679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/08/2007

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