Healthcare Provider Details

I. General information

NPI: 1831585140
Provider Name (Legal Business Name): DR. MAZIAR ESLAMI FARSANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3630
  • Fax: 951-784-3266
Mailing address:
  • Phone: 951-782-3630
  • Fax: 951-784-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA165854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: