Healthcare Provider Details

I. General information

NPI: 1548771330
Provider Name (Legal Business Name): FARBOD FARMAND DO A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

IV. Provider business mailing address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

V. Phone/Fax

Practice location:
  • Phone: 949-290-2701
  • Fax: 949-326-5099
Mailing address:
  • Phone: 949-215-5055
  • Fax: 949-326-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FARBOD FARMAND
Title or Position: CEO
Credential: D.O.
Phone: 949-290-2701