Healthcare Provider Details

I. General information

NPI: 1962449702
Provider Name (Legal Business Name): FOROUGH PARSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
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: 805-522-3909
Mailing address:
  • Phone: 805-522-1818
  • Fax: 805-522-3909

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:
Title or Position:
Credential:
Phone: