MEDICARE: HOSSEIN EFTEKHARI MD INC

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	207RI0011X	Interventional Cardiology Physician	A103425	CA
2	207RC0000X	Cardiovascular Disease Physician	A103425	CA

General Provider Information

NPI Number	:	1669974689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSSEIN EFTEKHARI MD INC

Provider Business Mailing Address
First Line	:	4147 PASCAL PL
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3941
Country	:	US
Telephone Number	:	832-483-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	4147 PASCAL PL
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3941
Country	:	US
Telephone Number	:	832-483-1509
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. HOSSEIN EFTEKHARI
Credential	:	MD
Telephone Number	:	832-483-1509

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	03/06/2018

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