Healthcare Provider Details

I. General information

NPI: 1912979048
Provider Name (Legal Business Name): MEHRAN NOWFAR-RAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S ARROYO PKWY
PASADENA CA
91105-3263
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 626-304-6300
  • Fax:
Mailing address:
  • Phone: 714-443-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA66360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: