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General NPI Number Information
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NPI Number | 1164824249
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Entity Type | Individual
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Provider Name | ALI GHORBANIFARAJZADEH DPM
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Gender | Male
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Dates
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Enumeration Date | 09/21/2014
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 500 OLD RIVER RD STE 185
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City | BAKERSFIELD
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State | CA
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Zip | 93311-9505
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Country | US
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Telephone | 661-832-3600
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Fax | 661-322-6249
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Provider Business Mailing Address
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Address Line | 11325 PARK SQUARE DR APT D204
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City | BAKERSFIELD
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State | CA
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Zip | 93311-8854
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Country | US
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Telephone | 305-310-8155
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Fax | 661-322-6249
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E5332
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | E5332
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License Number State | CA
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