Healthcare Provider Details

I. General information

NPI: 1083675821
Provider Name (Legal Business Name): FARIDEH FARID BAHRAMI RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

IV. Provider business mailing address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

V. Phone/Fax

Practice location:
  • Phone: 855-206-6764
  • Fax: 949-923-3575
Mailing address:
  • Phone: 855-206-6764
  • Fax: 949-923-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: