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General NPI Number Information
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NPI Number | 1164683090
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Entity Type | Organization
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Legal Business Name | ALIREZA PAKKAR MD INC
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 10921 WILSHIRE BLVD SUITE 412A
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City | LOS ANGELES
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State | CA
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Zip | 90024-3906
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Country | US
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Telephone | 310-301-3037
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Fax |
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Provider Business Mailing Address
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Address Line | 10921 WILSHIRE BLVD SUITE 412A
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City | LOS ANGELES
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State | CA
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Zip | 90024-3906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALIREZA PAKKAR
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Credential | M.D.
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Telephone | 310-301-3037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A56491
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License Number State | CA
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