Basic Information
| Provider Information | |||||||||
| NPI: | 1144551334 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL RADPARVAR MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 148 | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917110148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099852112 | ||||||||
| FaxNumber: | 9099853411 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 N LA CIENEGA BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103607368 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2010 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | RADPARVAR | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9099852112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A88567 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A885670 | 05 | CA | MEDICAID |