Healthcare Provider Details

I. General information

NPI: 1124239397
Provider Name (Legal Business Name): SIMA FARGAHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date: 04/01/2009
Reactivation Date: 10/28/2010

III. Provider practice location address

101 THE CITY DRIVE
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 2853
CAPISTRANO BEACH CA
92624
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: