Healthcare Provider Details

I. General information

NPI: 1841312972
Provider Name (Legal Business Name): FARANGIS JALALI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E SAN JACINTO AVE
PERRIS CA
92570-2878
US

IV. Provider business mailing address

4065 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-6700
  • Fax: 951-210-1418
Mailing address:
  • Phone: 951-358-5077
  • Fax: 951-358-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: