Provider Demographics
NPI:1972996262
Name:SEVO GAS, INC
Entity type:Organization
Organization Name:SEVO GAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:MANSOOR
Authorized Official - Last Name:KHAZAIELINAJAFABADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-732-6468
Mailing Address - Street 1:1210 TELLEM DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2246
Mailing Address - Country:US
Mailing Address - Phone:888-732-6468
Mailing Address - Fax:888-732-6468
Practice Address - Street 1:1210 TELLEM DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2246
Practice Address - Country:US
Practice Address - Phone:888-732-6468
Practice Address - Fax:888-732-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85856207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A858560Medicaid
CA00A858560Medicaid