Healthcare Provider Details

I. General information

NPI: 1396795233
Provider Name (Legal Business Name): SAMAN ARASH FARNOUSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 E ELWOOD ST STE 500
PHOENIX AZ
85040-1978
US

IV. Provider business mailing address

2528 BAYVIEW AVENUE PO BOX 35542
TORONTO ONTARIO
M2L 2Y4
CA

V. Phone/Fax

Practice location:
  • Phone: 602-200-9021
  • Fax:
Mailing address:
  • Phone: 416-856-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33804
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number33804
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: