Healthcare Provider Details

I. General information

NPI: 1639130933
Provider Name (Legal Business Name): SHARIAR Z BAVAFA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 OLD RANCH PARKWAY 3RD FLOOR STERLING PATHOLOGY LABORATORY
SEAL BEACH CA
90740
US

IV. Provider business mailing address

3020 OLD RANCH PARKWAY 3RD FLOOR
SEAL BEACH CA
90740
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-5518
  • Fax: 562-799-5544
Mailing address:
  • Phone: 562-799-5518
  • Fax: 562-799-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA43169
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA43169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: