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General NPI Number Information
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NPI Number | 1811004625
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Entity Type | Individual
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Provider Name | FARIBORZ LALEZARZADEH DO
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 164 W HOSPITALITY LN STE 100
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3316
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Country | US
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Telephone | 909-883-8834
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Fax | 909-644-4021
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Provider Business Mailing Address
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Address Line | 700 E REDLANDS BLVD STE U506
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City | REDLANDS
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State | CA
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Zip | 92373-6109
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Country | US
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Telephone | 909-883-8834
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Fax | 909-883-8834
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A8309
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License Number State | CA
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