Healthcare Provider Details

I. General information

NPI: 1255777843
Provider Name (Legal Business Name): REZA SHARAFI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9818 PARAMOUNT BLVD STE D
DOWNEY CA
90240-4407
US

IV. Provider business mailing address

9818 PARAMOUNT BLVD STE D
DOWNEY CA
90240-4407
US

V. Phone/Fax

Practice location:
  • Phone: 917-687-1256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96845
License Number StateCA

VIII. Authorized Official

Name: REZA SHARAFI
Title or Position: PRESIDENT
Credential: MD
Phone: 562-658-0499