Healthcare Provider Details

I. General information

NPI: 1689627143
Provider Name (Legal Business Name): MICHELLE ESLAMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WILSHIRE BLVD STE PR2
LOS ANGELES CA
90036-3689
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 200
LOS ANGELES CA
90045-5632
US

V. Phone/Fax

Practice location:
  • Phone: 310-739-4026
  • Fax: 631-350-0287
Mailing address:
  • Phone: 310-206-8272
  • Fax: 310-794-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA53670
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA53670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: