MEDICARE: MR. FARSHID FARAJZADEH PT, DPT

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	225100000X	Physical Therapist	PT20075	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT20075	OTHER	CA	PHYSCIAL THERAPY LIC #

General Provider Information

NPI Number	:	1326265422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FARSHID FARAJZADEH PT, DPT

Provider Business Mailing Address
First Line	:	4501 MISSION BAY DR
Second Line	:	STE 3K
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4926
Country	:	US
Telephone Number	:	858-531-3700
Fax Number	:	858-866-0342

Provider Business Practice Location Address
First Line	:	4501 MISSION BAY DR STE 3K
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4926
Country	:	US
Telephone Number	:	858-866-0340
Fax Number	:	858-866-0342

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/07/2016

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