Healthcare Provider Details

I. General information

NPI: 1336491521
Provider Name (Legal Business Name): ARRASH FARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MACAW LN
SIMI VALLEY CA
93065-3152
US

IV. Provider business mailing address

124 MACAW LN
SIMI VALLEY CA
93065-3152
US

V. Phone/Fax

Practice location:
  • Phone: 805-306-0304
  • Fax:
Mailing address:
  • Phone: 805-306-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA156502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: