Healthcare Provider Details

I. General information

NPI: 1023529823
Provider Name (Legal Business Name): FAREEN KOORJEE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N LAKE AVE
PASADENA CA
91104-4557
US

IV. Provider business mailing address

1812 GREVELIA ST
SOUTH PASADENA CA
91030-2785
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-4668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: