Provider Demographics
NPI:1285076240
Name:AFSANEH BAHMANI MD PROFESSIONAL CORP
Entity type:Organization
Organization Name:AFSANEH BAHMANI MD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-383-3317
Mailing Address - Street 1:381 ARNO WAY
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3348
Mailing Address - Country:US
Mailing Address - Phone:310-383-3317
Mailing Address - Fax:310-230-7757
Practice Address - Street 1:381 ARNO WAY
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3348
Practice Address - Country:US
Practice Address - Phone:310-383-3317
Practice Address - Fax:310-230-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61989207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty