MEDICARE: DR. AMIR POOYAN FAGHFOORY 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	2084P0800X	Psychiatry Physician	A112232	CA
2	2084P0800X	Psychiatry Physician	D85191	MD

General Provider Information

NPI Number	:	1245558105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR POOYAN FAGHFOORY M.D.

Provider Business Mailing Address
First Line	:	27281 LAS RAMBLAS STE 200
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-8303
Country	:	US
Telephone Number	:	310-367-2532
Fax Number	:

Provider Business Practice Location Address
First Line	:	27281 LAS RAMBLAS STE 200
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-8303
Country	:	US
Telephone Number	:	310-367-2532
Fax Number	:

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	01/09/2020

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