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General NPI Number Information
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NPI Number | 1992255723
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Entity Type | Organization
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Legal Business Name | SHAHVAR LLC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 1800 E VAN BUREN ST
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City | PHOENIX
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State | AZ
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Zip | 85006-3742
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Country | US
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Telephone | 602-251-8652
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33306
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City | PHOENIX
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State | AZ
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Zip | 85067-3306
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Country | US
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Telephone | 602-510-1340
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. PARVIZ SHAHVAR
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Credential | MD
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Telephone | 602-510-1340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22714
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License Number State | AZ
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