=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396756060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID SAFIANOFF M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 09/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2485 HIGH SCHOOL AVE SUITE 301
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-676-2942
-----------------------------------------------------
Fax | 925-676-7108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 RELIEZ VALLEY CT
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94549-1905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-939-4068
-----------------------------------------------------
Fax | 925-939-7424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | G227470
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------