Healthcare Provider Details

I. General information

NPI: 1063027886
Provider Name (Legal Business Name): ANAHID ESLAMI FARSANI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20360 SW BIRCH ST STE 120
NEWPORT BEACH CA
92660-1532
US

IV. Provider business mailing address

117 SAINT VINCENT
IRVINE CA
92618-3900
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-9551
  • Fax:
Mailing address:
  • Phone: 949-554-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA60711
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: