Healthcare Provider Details

I. General information

NPI: 1245055151
Provider Name (Legal Business Name): MUTAHIR FARHAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 02/20/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 DUPONT ST STE 130
CORONA CA
92879-6029
US

IV. Provider business mailing address

20810 BAKAL DR
RIVERSIDE CA
92508-2983
US

V. Phone/Fax

Practice location:
  • Phone: 951-497-3749
  • Fax: 954-405-8701
Mailing address:
  • Phone: 951-497-3749
  • Fax: 954-405-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN DARIUS
Title or Position: BILLING MANAGER
Credential:
Phone: 424-728-7877