Healthcare Provider Details

I. General information

NPI: 1669487435
Provider Name (Legal Business Name): FARIDEH FARROHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18546 ROSCOE BLVD 211
NORTHRIDGE CA
91324-4663
US

IV. Provider business mailing address

865 COMSTOCK AVE 12B
LOS ANGELES CA
90024-2572
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-8040
  • Fax: 818-885-8355
Mailing address:
  • Phone: 310-859-7536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA36865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: