Provider Demographics
NPI:1679516314
Name:ANVAR, BARDIA AARON (MD)
Entity type:Individual
Prefix:DR
First Name:BARDIA
Middle Name:AARON
Last Name:ANVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 WILSHIRE BLVD
Mailing Address - Street 2:#745
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:714-262-2886
Mailing Address - Fax:
Practice Address - Street 1:12021 WILSHIRE BLVD
Practice Address - Street 2:#745
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1206
Practice Address - Country:US
Practice Address - Phone:714-262-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86336208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86336OtherCA MEDICAL LICENSE
CAWA86336CMedicare PIN
CAWA86336AMedicare PIN
CAAV977YMedicare PIN
CAA86336OtherCA MEDICAL LICENSE
CAAV977ZMedicare PIN