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General NPI Number Information
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NPI Number | 1417416272
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Entity Type | Individual
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Provider Name | EDWIN AMIRIANFAR DO
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90067-2006
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Country | US
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Telephone | 424-363-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1548 KELTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90024-5504
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 05597
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 20A22377
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License Number State | CA
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