Healthcare Provider Details

I. General information

NPI: 1144802380
Provider Name (Legal Business Name): ALIREZA FARMANIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W BIRCH ST
CALEXICO CA
92231-2348
US

IV. Provider business mailing address

31 POTOMAC
IRVINE CA
92620-3255
US

V. Phone/Fax

Practice location:
  • Phone: 760-768-3169
  • Fax:
Mailing address:
  • Phone: 949-537-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: