Basic Information
| Provider Information | |||||||||
| NPI: | 1780889816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAFA MINAZAD D.O., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 S. RAYMOND AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265359344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 630 S. RAYMOND AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265359344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | MINAZAD | ||||||||
| AuthorizedOfficialFirstName: | YAFA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6265359344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 20A7974 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.