Provider Demographics
NPI:1053539908
Name:ARMIN VISHTEH, M.D., P.C.
Entity type:Organization
Organization Name:ARMIN VISHTEH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VISHTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-980-8010
Mailing Address - Street 1:PO BOX 25166
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0166
Mailing Address - Country:US
Mailing Address - Phone:909-980-8010
Mailing Address - Fax:909-980-8084
Practice Address - Street 1:7777 MILLIKEN AVE
Practice Address - Street 2:STE.125
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6780
Practice Address - Country:US
Practice Address - Phone:909-980-8010
Practice Address - Fax:909-980-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69896207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A698960Medicaid
CA00A698960Medicaid
CAW16542AMedicare PIN
CAG78478Medicare UPIN