Healthcare Provider Details

I. General information

NPI: 1639238371
Provider Name (Legal Business Name): PEYMAN SALIMI-TARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE STE 351
FOUNTAIN VALLEY CA
92708-7516
US

IV. Provider business mailing address

11180 WARNER AVE STE 351
FOUNTAIN VALLEY CA
92708-7516
US

V. Phone/Fax

Practice location:
  • Phone: 714-698-0300
  • Fax: 714-698-0313
Mailing address:
  • Phone: 714-698-0300
  • Fax: 714-698-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA104791
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA104791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: