Healthcare Provider Details

I. General information

NPI: 1740485101
Provider Name (Legal Business Name): FARHAD GHASEMI NIKOO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FARHAD GHASEMI-NIKOO NP

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 BUSINESS CENTER DR STE 255
IRVINE CA
92612-1162
US

IV. Provider business mailing address

PO BOX 6040
IRVINE CA
92616-6040
US

V. Phone/Fax

Practice location:
  • Phone: 714-769-6090
  • Fax:
Mailing address:
  • Phone: 714-769-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number726112
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18138
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: