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General NPI Number Information
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NPI Number | 1164805875
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Entity Type | Organization
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Legal Business Name | S AMIR FARZAN TAVAKKOLI ISFAHANI
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 27871 LA PAZ RD
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3920
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Country | US
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Telephone | 949-360-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 27871 LA PAZ RD
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3920
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Country | US
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Telephone | 949-360-1600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEID AMIR FARZAN TAVAKKOLI ISFAHANI
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Credential |
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Telephone | 256-797-2552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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