Healthcare Provider Details

I. General information

NPI: 1376935163
Provider Name (Legal Business Name): QARMON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4843 ARLINGTON AVE
RIVERSIDE CA
92504-2760
US

IV. Provider business mailing address

280 S LEMON AVE #210
WALNUT CA
91788-2685
US

V. Phone/Fax

Practice location:
  • Phone: 951-405-8500
  • Fax: 951-405-8555
Mailing address:
  • Phone: 951-405-8500
  • Fax: 951-405-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberE5163
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SAHAND GOLSHAN-KHALILI
Title or Position: PRESIDENT
Credential: D.P.M
Phone: 626-298-0707