MEDICARE: DR. PELMA TABRIZI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A82936	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	572-192-3	OTHER		ECFMG NUMBER

General Provider Information

NPI Number	:	1568497998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PELMA TABRIZI M.D.

Provider Business Mailing Address
First Line	:	1220 HEMLOCK WAY STE 205
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3655
Country	:	US
Telephone Number	:	714-884-4855
Fax Number	:	714-834-1076

Provider Business Practice Location Address
First Line	:	1220 HEMLOCK WAY STE 205
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3655
Country	:	US
Telephone Number	:	714-884-4855
Fax Number	:	714-834-1076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/07/2023

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