Healthcare Provider Details

I. General information

NPI: 1700503521
Provider Name (Legal Business Name): FARSHAD NAYSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N ROXBURY DR
BEVERLY HILLS CA
90210-5090
US

IV. Provider business mailing address

277 S SPALDING DR UNIT 202
BEVERLY HILLS CA
90212-3656
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-6123
  • Fax:
Mailing address:
  • Phone: 310-271-6123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: