Basic Information
| Provider Information | |||||||||
| NPI: | 1700153590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MANSOUR TAFAZOLI, MD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3640 LOMITA BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103758088 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3640 LOMITA BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103758088 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2011 | ||||||||
| LastUpdateDate: | 11/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | TAFAZOLI | ||||||||
| AuthorizedOfficialFirstName: | MANSOUR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3103758088 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A46577 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.