Provider Demographics
NPI:1720235369
Name:SAFAIE, MOHSEN
Entity type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:SAFAIE
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 1:820 34TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2283
Mailing Address - Country:US
Mailing Address - Phone:661-324-4844
Mailing Address - Fax:661-636-0903
Practice Address - Street 1:655 S FLOWER ST
Practice Address - Street 2:SUITE 368
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2805
Practice Address - Country:US
Practice Address - Phone:213-430-9180
Practice Address - Fax:213-430-9193
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty