=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043249808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FARZAN SHABBIR RAJPUT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 03/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 NEWPORT CENTER DR SUITE 110
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-870-6668
-----------------------------------------------------
Fax | 949-229-6462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2716
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92659-0170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-870-6668
-----------------------------------------------------
Fax | 949-229-6462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A95017
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------