MEDICARE: PRECISION OCCUPATIONAL MEDICAL GROUP, 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	208100000X	Physical Medicine & Rehabilitation Physician	FNP 35685	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601761702	OTHER	CA	US DEPT. OF LABOR
2	ZZZ52888Y	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1821290024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION OCCUPATIONAL MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1809 E DYER RD STE 313
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5740
Country	:	US
Telephone Number	:	949-955-0022
Fax Number	:	949-955-0220

Provider Business Practice Location Address
First Line	:	1321 NORTH GARVEY AVE. WEST
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2242
Country	:	US
Telephone Number	:	949-955-0022
Fax Number	:	949-955-0220

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHAHRIAR BAMSHAD
Credential	:	M.D.
Telephone Number	:	949-955-0022

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	03/04/2010

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