Individual
ARDESHIR KHOSRAVIANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3989 W STETSON AVE, SUITE 202, HEMET, CA 92545-9695
(951) 652-3558
(951) 652-5547
Mailing address
PO BOX 54130, LOS ANGELES, CA 90054-0130
(951) 687-3200
(951) 687-8923
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A122319
CA
207RN0300X
Nephrology Physician
Primary
A122319
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346569779
—
CA
Enumeration date
05/25/2010
Last updated
11/29/2021
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