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General NPI Number Information
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NPI Number | 1285963124
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Entity Type | Organization
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Legal Business Name | FARIBORZ LALEZARZADEH DO INC
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 164 W HOSPITALITY LN STE 100
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3316
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Country | US
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Telephone | 909-883-8834
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Fax | 909-644-4021
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Provider Business Mailing Address
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Address Line | 700 E REDLANDS BLVD STE U506
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City | REDLANDS
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State | CA
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Zip | 92373-6109
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Country | US
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Telephone | 909-883-8834
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Fax | 909-883-8834
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARIBORZ LALEZARZADEH
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Credential | DO
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Telephone | 909-883-8834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 20A8309
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License Number State | CA
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