Healthcare Provider Details

I. General information

NPI: 1851223093
Provider Name (Legal Business Name): PARVANEH GHANBARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S 12TH AVE STE 1
YAKIMA WA
98902-3149
US

IV. Provider business mailing address

123 BROADWAY APT 631
SEATTLE WA
98122-7035
US

V. Phone/Fax

Practice location:
  • Phone: 509-606-2662
  • Fax:
Mailing address:
  • Phone: 360-961-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.MD.70163018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: