MEDICARE: FARDAD BAROUMAND MD

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A103643	CA

General Provider Information

NPI Number	:	1245319375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARDAD BAROUMAND MD

Provider Business Mailing Address
First Line	:	15047 LOS GATOS BLVD
Second Line	:	STE.200
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2054
Country	:	US
Telephone Number	:	408-364-6799
Fax Number	:	408-378-4510

Provider Business Practice Location Address
First Line	:	15047 LOS GATOS BLVD
Second Line	:	STE.200
City	:	LOS GATOS
State	:	CA
Zip	:	95032-2054
Country	:	US
Telephone Number	:	408-364-6799
Fax Number	:	408-378-4510

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	12/22/2011

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Directions to “ FARDAD BAROUMAND MD” Practice Location

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