Healthcare Provider Details

I. General information

NPI: 1215936059
Provider Name (Legal Business Name): FARSHID NEJAD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WILSHIRE BLVD STE 280E
BEVERLY HILLS CA
90212-3562
US

IV. Provider business mailing address

11901 SANTA MONICA BLVD
LOS ANGELES CA
90025-2767
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3668
  • Fax: 310-652-3669
Mailing address:
  • Phone: 310-652-3668
  • Fax: 310-652-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4525
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: