Healthcare Provider Details

I. General information

NPI: 1588191621
Provider Name (Legal Business Name): FARNAZ FARAMARZI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11959 MARIPOSA RD
HESPERIA CA
92345-1696
US

IV. Provider business mailing address

555 N 13TH AVE
UPLAND CA
91786-4904
US

V. Phone/Fax

Practice location:
  • Phone: 800-345-8979
  • Fax:
Mailing address:
  • Phone: 92-061-0979
  • Fax: 909-277-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: