Healthcare Provider Details

I. General information

NPI: 1730341835
Provider Name (Legal Business Name): TINA ASHRAFZADEH D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SILVER SPUR RD STE 240
ROLLING HILLS ESTATES CA
90275-3612
US

IV. Provider business mailing address

550 SILVER SPUR RD STE 240
ROLLING HILLS ESTATES CA
90275-3612
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-8900
  • Fax: 310-792-8907
Mailing address:
  • Phone: 310-792-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: