Healthcare Provider Details

I. General information

NPI: 1073846762
Provider Name (Legal Business Name): FARSHAD FANI MARVASTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2009
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 N PIMA CENTER PKWY STE 203
SCOTTSDALE AZ
85258-4670
US

IV. Provider business mailing address

PO BOX 8468
SCOTTSDALE AZ
85252-8468
US

V. Phone/Fax

Practice location:
  • Phone: 480-587-6930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number48330
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48330
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA109454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: