Basic Information
| Provider Information | |||||||||
| NPI: | 1679516314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANVAR | ||||||||
| FirstName: | BARDIA | ||||||||
| MiddleName: | AARON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12021 WILSHIRE BLVD | ||||||||
| Address2: | #745 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900251206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142622886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12021 WILSHIRE BLVD | ||||||||
| Address2: | #745 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900251206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142622886 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A86336 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | A86336 | 01 | CA | CA MEDICAL LICENSE | OTHER |