MEDICARE: FARAH FERRER MD MEDICAL GROUP INC

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
1	171W00000X	Contractor
2	2084P0015X	Psychosomatic Medicine Physician

General Provider Information

NPI Number	:	1164549598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARAH FERRER MD MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	5406 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2208
Country	:	US
Telephone Number	:	323-573-6010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5406 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2208
Country	:	US
Telephone Number	:	323-213-3605
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FARAH FERRER
Credential	:	MD
Telephone Number	:	818-854-6971

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/13/2023

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