Healthcare Provider Details

I. General information

NPI: 1316061781
Provider Name (Legal Business Name): SHAWN FARROKHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SOUTH RAYMOND AVE SUITE 120
PASADENA CA
91105
US

IV. Provider business mailing address

630 SOUTH RAYMOND AVE SUITE 120
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-1444
  • Fax: 626-403-1448
Mailing address:
  • Phone: 626-403-1444
  • Fax: 626-403-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 28615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: