Provider Demographics
NPI:1265976351
Name:BARDIA SADR MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:BARDIA SADR MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SADR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-310-3701
Mailing Address - Street 1:131 CARMINE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0878
Mailing Address - Country:US
Mailing Address - Phone:949-310-3701
Mailing Address - Fax:866-440-4397
Practice Address - Street 1:800 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3420
Practice Address - Country:US
Practice Address - Phone:951-737-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARDIA SADR MD A PROFESSIONAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty