Healthcare Provider Details

I. General information

NPI: 1760415236
Provider Name (Legal Business Name): FARBOD ASGARZADIE-GADIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 SIERRA AVE MOB 8
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9985 SIERRA AVE MOB 8
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 866-454-3485
  • Fax:
Mailing address:
  • Phone: 866-454-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA92692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: