MEDICARE: FARSHAD SIRJANI OSTOVAR M.D.

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	207Q00000X	Family Medicine Physician	A167627	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1194706846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARSHAD SIRJANI OSTOVAR M.D.

Provider Business Mailing Address
First Line	:	4770 W HERNDON AVE # 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-8401
Country	:	US
Telephone Number	:	559-450-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 W HERNDON AVE # 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-8401
Country	:	US
Telephone Number	:	559-450-0463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	04/04/2022

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