Basic Information
| Provider Information | |||||||||
| NPI: | 1881705945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REZA ESFAHANI, D.O., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4277 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801554277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032205707 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6161 S SYRACUSE WAY | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032205707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ESFAHANI | ||||||||
| AuthorizedOfficialFirstName: | REZA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3032205707 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36069 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 59379006 | 05 | CO | MEDICAID |