Healthcare Provider Details

I. General information

NPI: 1265976351
Provider Name (Legal Business Name): BARDIA SADR MD A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882-3420
US

IV. Provider business mailing address

131 CARMINE
IRVINE CA
92618-0878
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-4343
  • Fax:
Mailing address:
  • Phone: 949-310-3701
  • Fax: 866-440-4397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BARDIA SADR
Title or Position: OWNER
Credential: MD
Phone: 949-310-3701