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General NPI Number Information
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NPI Number | 1568698843
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Entity Type | Individual
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Provider Name | OMAR M FARIDI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 06/01/2009
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Provider Practice Location Address
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Address Line | 1200 N STATE ST CT A3C 117
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City | LOS ANGELES
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State | CA
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Zip | 90033-1029
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Country | US
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Telephone | 323-409-5051
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Fax |
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Provider Business Mailing Address
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Address Line | 947 CRYSTAL WATER LN
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City | WALNUT
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State | CA
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Zip | 91789-1467
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Country | US
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Telephone | 909-839-3509
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Fax |
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | A107924
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License Number State | CA
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