Provider Demographics
NPI:1063514479
Name:ESFANDIARIFARD, ESFANDIAR (MD)
Entity type:Individual
Prefix:DR
First Name:ESFANDIAR
Middle Name:
Last Name:ESFANDIARIFARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 VENTURA BLVD STE 515
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1972
Mailing Address - Country:US
Mailing Address - Phone:818-990-4030
Mailing Address - Fax:818-990-4031
Practice Address - Street 1:16661 VENTURA BLVD STE 515
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1972
Practice Address - Country:US
Practice Address - Phone:818-990-4030
Practice Address - Fax:818-990-4031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A740460OtherBC/BS
A74046OtherBC/BS
CA00A740460Medicaid
WA74046BMedicare ID - Type Unspecified
00A740460OtherBC/BS
A74046OtherBC/BS