Provider Demographics
NPI:1588709992
Name:P TAHERPOUR M.D.INC
Entity type:Organization
Organization Name:P TAHERPOUR M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-626-5679
Mailing Address - Street 1:124 N VIGNES ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4030
Mailing Address - Country:US
Mailing Address - Phone:213-626-5679
Mailing Address - Fax:213-680-0185
Practice Address - Street 1:124 N VIGNES ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4030
Practice Address - Country:US
Practice Address - Phone:213-626-5679
Practice Address - Fax:213-680-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28671261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A286710Medicaid
CA00A286710Medicaid