Healthcare Provider Details

I. General information

NPI: 1144223926
Provider Name (Legal Business Name): FARIBA NAVID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3701 WILSHIRE BLVD 600
LOS ANGELES CA
90010-2804
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-4100
  • Fax: 323-361-3642
Mailing address:
  • Phone: 323-361-2337
  • Fax: 323-361-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number36980
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberC145696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: