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General NPI Number Information
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NPI Number | 1629827084
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Entity Type | Organization
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Legal Business Name | PANTEA PAHLAVAN, MD
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Dates
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Enumeration Date | 05/16/2024
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5140 BUSINESS CENTER DR STE 13
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City | FAIRFIELD
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State | CA
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Zip | 94534-1793
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Country | US
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Telephone | 707-736-6900
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Fax | 707-931-4755
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Provider Business Mailing Address
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Address Line | 5140 BUSINESS CENTER DR STE 103
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City | FAIRFIELD
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State | CA
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Zip | 94534-1794
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Country | US
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Telephone | 510-325-9805
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PANTEA PAHLAVAN
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Credential | MD
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Telephone | 510-325-9805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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