MEDICARE: PEDRAM NAVAB DO INC

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	207YS0012X	Sleep Medicine (Otolaryngology) Physician
2	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1720465578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDRAM NAVAB DO INC

Provider Business Mailing Address
First Line	:	1180 N INDIAN CANYON DR
Second Line	:	SUITE W201
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4800
Country	:	US
Telephone Number	:	760-416-4511
Fax Number	:	760-416-4515

Provider Business Practice Location Address
First Line	:	1180 N INDIAN CANYON DRIVE
Second Line	:	SUITE W201
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4402
Country	:	US
Telephone Number	:	760-416-4511
Fax Number	:	760-416-4515

Authorized Official
Title or Position	:	OSTEOPATHIC DOCTOR
Name	:	DR. PEDRAM NAVAB
Credential	:	D.O.
Telephone Number	:	760-416-4511

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	05/05/2015

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