Healthcare Provider Details

I. General information

NPI: 1073602157
Provider Name (Legal Business Name): DR. FARIBA MATINFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NONE NONE D.D.S.

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E DEL AMO BLVD
CARSON CA
90746-3314
US

IV. Provider business mailing address

PO BOX 11021
BEVERLY HILLS CA
90213-4521
US

V. Phone/Fax

Practice location:
  • Phone: 310-515-5672
  • Fax:
Mailing address:
  • Phone: 323-528-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number43547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: