Healthcare Provider Details

I. General information

NPI: 1902053663
Provider Name (Legal Business Name): FARID KIA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FARID FARZANEHKIA

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PASEO CAMARILLO
CAMARILLO CA
93010-6073
US

IV. Provider business mailing address

237 TOWN CTR W # 274
SANTA MARIA CA
93458-5075
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-5201
  • Fax: 805-782-8097
Mailing address:
  • Phone: 805-345-2334
  • Fax: 805-782-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA125119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: