MEDICARE: FARROKH ALEMZADEH M D INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A55448	OTHER	CA	STATE LICENSE
2	PCP 1203	OTHER	CA	MONARCH HEALTH CARE
3	ZZZ67835Z	OTHER	CA	BLUE SHIELD
4	ZZZ67836Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1871529297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARROKH ALEMZADEH M D INC

Provider Business Mailing Address
First Line	:	655 CAMINO DE LOS MARES STE 207
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2809
Country	:	US
Telephone Number	:	949-654-4325
Fax Number	:	949-654-8730

Provider Business Practice Location Address
First Line	:	655 CAMINO DE LOS MARES STE 207
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2809
Country	:	US
Telephone Number	:	949-654-4325
Fax Number	:	949-654-8730

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FARROKH ALEMZADEH
Credential	:	M.D.
Telephone Number	:	949-654-4325

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	11/17/2022

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