Healthcare Provider Details

I. General information

NPI: 1710294665
Provider Name (Legal Business Name): FOROUGH PARSA MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SYCAMORE DR SUITE 300
SIMI VALLEY CA
93065-1207
US

IV. Provider business mailing address

2925 SYCAMORE DR SUITE 300
SIMI VALLEY CA
93065-1207
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-1818
  • Fax:
Mailing address:
  • Phone: 805-522-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA29656
License Number StateCA

VIII. Authorized Official

Name: FOROUGH PARSA
Title or Position: PRESIDENT
Credential: MD
Phone: 805-522-1818