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General NPI Number Information
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NPI Number | 1346192622
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Entity Type | Organization
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Legal Business Name | SOCAL FACIAL PLASTIC SURGERY, INC
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 6800 INDIANA AVE STE 280
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City | RIVERSIDE
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State | CA
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Zip | 92506-7205
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Country | US
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Telephone | 304-881-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 INDIANA AVE STE 280
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City | RIVERSIDE
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State | CA
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Zip | 92506-7205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SURGEON
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Name | ADEEB DERAKHSHAN
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Credential | MD
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Telephone | 951-783-9198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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