Healthcare Provider Details

I. General information

NPI: 1932380219
Provider Name (Legal Business Name): MARJAN MONFARED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DR STE 102
FOOTHILL RANCH CA
92610-2857
US

IV. Provider business mailing address

21821 LANAR
MISSION VIEJO CA
92692-1041
US

V. Phone/Fax

Practice location:
  • Phone: 949-380-1234
  • Fax: 949-305-2230
Mailing address:
  • Phone: 949-380-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberA96525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: