=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578616686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ARYANPUR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2752 HARRISON AVE SUITE A
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95501-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-268-0190
-----------------------------------------------------
Fax | 707-269-3791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2752 HARRISON AVE SUITE A
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95501-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-268-0190
-----------------------------------------------------
Fax | 707-269-3791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | G76773
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------