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NPI Code Detail

MEDICARE: FARIBORZ DAVID FAKHRI D.O.

MEDICARE: FARIBORZ DAVID FAKHRI D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician20A8959CA

General Provider Information

NPI Number : 1104890326
Entity Type Code : Individual
Provider Name (Legal Business Name) : FARIBORZ DAVID FAKHRI D.O.
Provider Business Mailing Address
First Line : PO BOX 19478
Second Line :
City : SACRAMENTO
State : CA
Zip : 95819-0478
Country : US
Telephone Number : 916-454-5695
Fax Number :
Provider Business Practice Location Address
First Line : 4250 AUBURN BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-4100
Country : US
Telephone Number : 916-489-3336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 06/06/2014

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