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NPI Code Detail

MEDICARE: LAMORINDA ENT FACE & NECK SURGERY INC

MEDICARE: LAMORINDA ENT FACE & NECK SURGERY INC
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
1207Y00000XOtolaryngology PhysicianA85934CA

General Provider Information

NPI Number : 1992985923
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAMORINDA ENT FACE & NECK SURGERY INC
Provider Business Mailing Address
First Line : 911 MORAGA ROAD
Second Line : SUITE 102
City : LAFAYETTE
State : CA
Zip : 94549
Country : US
Telephone Number : 925-299-9919
Fax Number : 925-299-9924
Provider Business Practice Location Address
First Line : 911 MORAGA ROAD
Second Line : SUITE 102
City : LAFAYETTE
State : CA
Zip : 94549-4591
Country : US
Telephone Number : 925-299-9919
Fax Number : 925-299-9924
Authorized Official
Title or Position : OTOLARYNGOLOGIST
Name : DR. SASSAN FALSAFI
Credential : MD
Telephone Number : 925-299-9919
Provider Enumeration Date : 11/07/2007
Last Update Date : 01/23/2012

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