Healthcare Provider Details

I. General information

NPI: 1457403859
Provider Name (Legal Business Name): LADAN FARHOOMAND, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 800-883-7243
  • Fax:
Mailing address:
  • Phone: 714-347-1012
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA83382
License Number StateCA

VIII. Authorized Official

Name: DR. LADAN FARHOOMAND
Title or Position: M.D.
Credential: M.D.
Phone: 800-883-7243