Provider Demographics
NPI:1447500269
Name:ESRAFIL ABEDI M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ESRAFIL ABEDI M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESRAFIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-470-0600
Mailing Address - Street 1:23961 CALLE MAGDALENA
Mailing Address - Street 2:430
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3685
Mailing Address - Country:US
Mailing Address - Phone:949-470-0600
Mailing Address - Fax:949-830-1095
Practice Address - Street 1:23961 CALLE MAGDALENA ST
Practice Address - Street 2:430
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3685
Practice Address - Country:US
Practice Address - Phone:949-470-0600
Practice Address - Fax:949-830-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30818207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30818Medicare UPIN