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General NPI Number Information
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NPI Number | 1598739120
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Entity Type | Individual
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Provider Name | FARANAK POURGHASEMI
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Gender | Female
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 14981 NATIONAL AVE STE 2
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City | LOS GATOS
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State | CA
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Zip | 95032-2600
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Country | US
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Telephone | 408-884-5851
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Fax | 408-884-1503
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Provider Business Mailing Address
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Address Line | 18817 MARTHA AVE
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City | SARATOGA
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State | CA
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Zip | 95070-4641
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Country | US
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Telephone | 510-432-8864
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4658
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License Number State | CA
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