Healthcare Provider Details

I. General information

NPI: 1649903055
Provider Name (Legal Business Name): ARESH SEPEHRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 07/04/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 MEADOW RIDGE DR
WINNIPEG MANITOBA
R3T 5N5
CA

IV. Provider business mailing address

42 MEADOW RIDGE DR
WINNIPEG MANITOBA
R3T 5N5
CA

V. Phone/Fax

Practice location:
  • Phone: 778-999-9124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: