Provider Demographics
NPI:1679948889
Name:BARZEGARBEHROZ, ELHAM
Entity type:Individual
Prefix:
First Name:ELHAM
Middle Name:
Last Name:BARZEGARBEHROZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BONITA ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3652
Mailing Address - Country:US
Mailing Address - Phone:877-787-7771
Mailing Address - Fax:877-788-8759
Practice Address - Street 1:141 BONITA ST UNIT 7
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3652
Practice Address - Country:US
Practice Address - Phone:877-787-7771
Practice Address - Fax:877-788-8759
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)