MEDICARE: DR. MUTAHIR FARHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A188941	CA
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	A188941	CA

General Provider Information

NPI Number	:	1033856661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUTAHIR FARHAN MD

Provider Business Mailing Address
First Line	:	20810 BAKAL DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-2983
Country	:	US
Telephone Number	:	951-497-3749
Fax Number	:	954-405-8701

Provider Business Practice Location Address
First Line	:	284 DUPONT ST STE 130
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-6029
Country	:	US
Telephone Number	:	951-497-3749
Fax Number	:	954-405-8701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	07/17/2025

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