Healthcare Provider Details

I. General information

NPI: 1538496419
Provider Name (Legal Business Name): DR. PARASTOU FARHADIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14427 CHASE ST UNIT 302
PANORAMA CITY CA
91402-3020
US

IV. Provider business mailing address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

V. Phone/Fax

Practice location:
  • Phone: 818-830-7751
  • Fax:
Mailing address:
  • Phone: 951-486-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberA109662
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA109662
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA109662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: