Healthcare Provider Details

I. General information

NPI: 1568633444
Provider Name (Legal Business Name): FARZAD YAGHOUTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 FRIARS RD STE 100
SAN DIEGO CA
92108-5107
US

IV. Provider business mailing address

6950 FRIARS RD STE 100
SAN DIEGO CA
92108-5107
US

V. Phone/Fax

Practice location:
  • Phone: 619-243-2444
  • Fax: 619-243-2443
Mailing address:
  • Phone: 619-243-2444
  • Fax: 619-243-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG85172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: