MEDICARE: SHAHRIYAR TAVAKOLI M.D.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	A48572	CA
2	207RP1001X	Pulmonary Disease Physician	A48572	CA

General Provider Information

NPI Number	:	1962407767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHRIYAR TAVAKOLI M.D.

Provider Business Mailing Address
First Line	:	41750 RANCHO LAS PALMAS DR STE M3
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-5511
Country	:	US
Telephone Number	:	760-895-4292
Fax Number	:	760-895-4015

Provider Business Practice Location Address
First Line	:	41750 RANCHO LAS PALMAS DR STE M3
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-5511
Country	:	US
Telephone Number	:	760-895-4292
Fax Number	:	760-895-4015

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	06/01/2026

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Directions to “ SHAHRIYAR TAVAKOLI M.D.” Practice Location

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