Healthcare Provider Details

I. General information

NPI: 1235244294
Provider Name (Legal Business Name): HOMAYOUN FAGHIHI-SHIRAZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

3700 LYON RD #124
FAIRFIELD CA
94534-7972
US

V. Phone/Fax

Practice location:
  • Phone: 707-435-2077
  • Fax:
Mailing address:
  • Phone: 707-435-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35995
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: