MEDICARE: GHOLAM H FARBOODY 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	174400000X	Specialist	C42647	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831110923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHOLAM H FARBOODY MD

Provider Business Mailing Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	SUITE 221
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-242-0475
Fax Number	:	818-662-0260

Provider Business Practice Location Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	SUITE 221
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-242-0475
Fax Number	:	818-662-0260

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/08/2007

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