Healthcare Provider Details

I. General information

NPI: 1013987890
Provider Name (Legal Business Name): FARZIN TAYEFEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CTR DR
CHULA VISTA CA
91911
US

IV. Provider business mailing address

332 S JUNIPER 108
ESCONDIDO CA
92025
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-5800
  • Fax:
Mailing address:
  • Phone: 760-746-1755
  • Fax: 760-746-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA73083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: