Healthcare Provider Details

I. General information

NPI: 1477945228
Provider Name (Legal Business Name): ROKHSAREH TAJRISHI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 E COAST HWY SUITE 570
CORONA DEL MAR CA
92625-2328
US

IV. Provider business mailing address

3334 E COAST HWY SUITE 570
CORONA DEL MAR CA
92625-2328
US

V. Phone/Fax

Practice location:
  • Phone: 714-903-7767
  • Fax: 714-903-7801
Mailing address:
  • Phone: 714-903-7767
  • Fax: 714-903-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA133047
License Number StateCA

VIII. Authorized Official

Name: DR. ROKHSAREH ROXANNE TAJRISHI
Title or Position: OWNER
Credential: M.D.
Phone: 949-478-2088