Healthcare Provider Details

I. General information

NPI: 1376774265
Provider Name (Legal Business Name): PARASTOO FARHOODI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 BARBARA CT
LOS ANGELES CA
90068-1700
US

IV. Provider business mailing address

3169 BARBARA CT
LOS ANGELES CA
90068-1700
US

V. Phone/Fax

Practice location:
  • Phone: 323-876-6440
  • Fax: 323-874-4022
Mailing address:
  • Phone: 323-876-6440
  • Fax: 323-874-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: