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General NPI Number Information
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NPI Number | 1609918119
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Entity Type | Individual
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Provider Name | FRESHTEH FARAHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 1629 MEDICAL ARTS BLVD STE 200
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City | ANDERSON
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State | IN
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Zip | 46011
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Country | US
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Telephone | 765-298-5439
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Fax | 765-298-4920
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Provider Business Mailing Address
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Address Line | 10845 GRIFFITH PEAK DR # 2
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City | LAS VEGAS
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State | NV
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Zip | 89135-1553
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Country | US
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Telephone | 818-572-0889
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01068742A
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License Number State | IN
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