MEDICARE: FARAMARZ ALAV 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	207R00000X	Internal Medicine Physician	A74033	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508825027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARAMARZ ALAV M.D.

Provider Business Mailing Address
First Line	:	16465 SIERRA LAKES PKWY STE 200
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-1242
Country	:	US
Telephone Number	:	909-429-2404
Fax Number	:	909-429-2030

Provider Business Practice Location Address
First Line	:	16465 SIERRA LAKES PKWY STE 200
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-1242
Country	:	US
Telephone Number	:	909-429-2404
Fax Number	:	909-429-2030

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	08/03/2020

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