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NPI Code Detail

MEDICARE: ALIREZA TABESH MD INC

MEDICARE: ALIREZA TABESH MD 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
1207RG0100XGastroenterology Physician

General Provider Information

NPI Number : 1730644519
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALIREZA TABESH MD INC
Provider Business Mailing Address
First Line : 14120 ALONDRA BLVD STE C
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-5842
Country : US
Telephone Number : 562-407-2080
Fax Number : 562-407-2082
Provider Business Practice Location Address
First Line : 2000 STADIUM WAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-2606
Country : US
Telephone Number : 213-250-4200
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ALIREZA TABESH
Credential : MD
Telephone Number : 562-407-2080
Provider Enumeration Date : 02/05/2019
Last Update Date : 02/05/2019

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