=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508816158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAHRIAR FARZAD M.D., A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 02/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 N. ROBERTSON BLVD. SUITE #316
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-247-8282
-----------------------------------------------------
Fax | 310-247-1418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 N. ROBERTSON BLVD. SUITE #316
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-247-8282
-----------------------------------------------------
Fax | 310-247-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | PARI FARZAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-247-8282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------