Healthcare Provider Details

I. General information

NPI: 1780341685
Provider Name (Legal Business Name): SEYED FARHAD REJALI ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD STE 412
LOS ANGELES CA
90048-5224
US

IV. Provider business mailing address

6221 WILSHIRE BLVD STE 412
LOS ANGELES CA
90048-5224
US

V. Phone/Fax

Practice location:
  • Phone: 310-740-3859
  • Fax:
Mailing address:
  • Phone: 888-888-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: