Provider Demographics
NPI:1023190014
Name:GHASEMI, FARIDEH (FNP)
Entity Type:Individual
Prefix:MS
First Name:FARIDEH
Middle Name:
Last Name:GHASEMI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11705 SLATE AVE
Mailing Address - Street 2:#200
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505
Mailing Address - Country:US
Mailing Address - Phone:800-274-3893
Mailing Address - Fax:951-359-1999
Practice Address - Street 1:11705 SLATE AVE
Practice Address - Street 2:#200
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505
Practice Address - Country:US
Practice Address - Phone:800-274-3893
Practice Address - Fax:951-359-1999
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16641363LF0000X
CANP16641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily