MEDICARE: DR. SASSAN FALSAFI 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	207Y00000X	Otolaryngology Physician	A85934	CA

General Provider Information

NPI Number	:	1306956362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SASSAN FALSAFI M.D.

Provider Business Mailing Address
First Line	:	911 MORAGA RD
Second Line	:	STE 102
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4591
Country	:	US
Telephone Number	:	925-299-9919
Fax Number	:	925-299-9924

Provider Business Practice Location Address
First Line	:	911 MORAGA RD
Second Line	:	SUITE 102
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4579
Country	:	US
Telephone Number	:	925-299-9919
Fax Number	:	510-635-9514

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/17/2018

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