=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346569472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARIBORZ DAVID SATEY, M.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2010
-----------------------------------------------------
Last Update Date | 03/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1707 WEST AVE J
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93534-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-949-5929
-----------------------------------------------------
Fax | 661-949-5464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 627 WEST AVENUE Q SUITE D
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93534-3891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-272-5656
-----------------------------------------------------
Fax | 661-272-0909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FARIBORZ DAVID SATEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 661-272-5656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A53170
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------