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General NPI Number Information
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NPI Number | 1205370749
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Entity Type | Organization
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Legal Business Name | AMIR FAGHFOORY, MD, APC
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 12304 SANTA MONICA BLVD 334
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City | LOS ANGELES
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State | CA
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Zip | 90025-2551
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Country | US
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Telephone | 310-367-2532
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Fax | 310-820-8031
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Provider Business Mailing Address
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Address Line | 12304 SANTA MONICA BLVD 334
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City | LOS ANGELES
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State | CA
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Zip | 90025-2551
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Country | US
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Telephone | 310-367-2532
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Fax | 310-820-8031
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. AMIR POOYAN FAGHFOORY
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Credential | M.D.
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Telephone | 310-367-2532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A112232
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License Number State | CA
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