Healthcare Provider Details

I. General information

NPI: 1477784338
Provider Name (Legal Business Name): AFSHIN ZADFAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 09/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W FERN AVE
REDLANDS CA
92373-5916
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-3311
  • Fax:
Mailing address:
  • Phone: 909-335-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA106756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: