Provider Demographics
NPI:1568882751
Name:MARVASTI, AMIR HOSSEIN ALIM
Entity type:Individual
Prefix:
First Name:AMIR HOSSEIN
Middle Name:ALIM
Last Name:MARVASTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 LONG BEACH BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2008
Mailing Address - Country:US
Mailing Address - Phone:562-591-7700
Mailing Address - Fax:562-591-1311
Practice Address - Street 1:363 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3813
Practice Address - Country:US
Practice Address - Phone:714-771-1213
Practice Address - Fax:714-771-7126
Is Sole Proprietor?:No
Enumeration Date:2014-04-26
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA140382207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program