=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700061512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARVIZ D. DANIELS, M.D.,, F.A.C.S., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2007
-----------------------------------------------------
Last Update Date | 03/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6221 WILSHIRE BLVD SUITE 205
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-933-7571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6221 WILSHIRE BLVD SUITE 205
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-933-7571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER MAYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-933-7571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | A36510
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------