Healthcare Provider Details

I. General information

NPI: 1649280272
Provider Name (Legal Business Name): HESSAM S. EFTEKHARI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31371 RANCHO VIEJO RD STE 104
SAN JUAN CAPISTRANO CA
92675-1848
US

IV. Provider business mailing address

31371 RANCHO VIEJO RD STE 104
SAN JUAN CAPISTRANO CA
92675-1848
US

V. Phone/Fax

Practice location:
  • Phone: 949-565-0444
  • Fax: 949-565-0446
Mailing address:
  • Phone: 949-565-0444
  • Fax: 949-565-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A9311
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number20A9311
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number20A9311
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number20A9311
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A9311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: