Healthcare Provider Details

I. General information

NPI: 1629107636
Provider Name (Legal Business Name): FARID YASHARPOUR M.D A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14671 RINALDI ST
SAN FERNANDO CA
91340-4199
US

IV. Provider business mailing address

14671 RINALDI ST
SAN FERNANDO CA
91340-4199
US

V. Phone/Fax

Practice location:
  • Phone: 818-270-9030
  • Fax: 818-270-9039
Mailing address:
  • Phone: 818-270-9030
  • Fax: 818-270-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA65312
License Number StateCA

VIII. Authorized Official

Name: MISS CHERYL R SPENCE
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 818-270-9030