Healthcare Provider Details

I. General information

NPI: 1992258156
Provider Name (Legal Business Name): MAHSHID FAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 12/13/2021
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE ARRORWHEAD REGIONAL MEDICAL CENTER
COLTON CA
92324
US

IV. Provider business mailing address

218 N 2ND ST
ALLENTOWN PA
18102-3508
US

V. Phone/Fax

Practice location:
  • Phone: 855-422-8029
  • Fax:
Mailing address:
  • Phone: 610-841-8400
  • Fax: 610-841-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: