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General NPI Number Information
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NPI Number | 1487793741
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Entity Type | Individual
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Provider Name | MR. FARIBORZ DAVID MASSOUDI
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 891 W 9TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-3603
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Country | US
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Telephone | 310-833-2575
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Fax | 310-832-2531
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Provider Business Mailing Address
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Address Line | 891 W 9TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-3603
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Country | US
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Telephone | 310-833-2575
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Fax | 310-832-2531
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY45471
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY45471
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License Number State | CA
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