Healthcare Provider Details

I. General information

NPI: 1073884474
Provider Name (Legal Business Name): DR ALIREZA PESSARAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 FAIR OAKS BLVD
CARMICHAEL CA
95608-4021
US

IV. Provider business mailing address

6437 FAIR OAKS BLVD
CARMICHAEL CA
95608-4021
US

V. Phone/Fax

Practice location:
  • Phone: 916-489-3641
  • Fax: 916-489-2770
Mailing address:
  • Phone: 916-489-3641
  • Fax: 916-489-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberGNB32009-43470
License Number StateCA

VIII. Authorized Official

Name: DR. ALIREZA PESSARAN
Title or Position: OWNER
Credential: M.D.
Phone: 916-489-3641