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General NPI Number Information
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NPI Number | 1992985923
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Entity Type | Organization
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Legal Business Name | LAMORINDA ENT FACE & NECK SURGERY INC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 911 MORAGA ROAD SUITE 102
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City | LAFAYETTE
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State | CA
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Zip | 94549-4591
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Country | US
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Telephone | 925-299-9919
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Fax | 925-299-9924
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Provider Business Mailing Address
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Address Line | 911 MORAGA ROAD SUITE 102
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City | LAFAYETTE
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State | CA
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Zip | 94549
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Country | US
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Telephone | 925-299-9919
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Fax | 925-299-9924
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Authorized Official
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Title or Position | OTOLARYNGOLOGIST
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Name | DR. SASSAN FALSAFI
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Credential | MD
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Telephone | 925-299-9919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | A85934
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License Number State | CA
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