Basic Information
| Provider Information | |||||||||
| NPI: | 1235394875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROKNEDIN SAFAVI MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3255 ESPLANADE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959730255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308993150 | ||||||||
| FaxNumber: | 5308993160 | ||||||||
| Practice Location | |||||||||
| Address1: | 3255 ESPLANADE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959730255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308993150 | ||||||||
| FaxNumber: | 5308993160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | SAFAVI | ||||||||
| AuthorizedOfficialFirstName: | ROKNEDIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5308993150 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35045246 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0510012 | 05 | OH | MEDICAID |