Provider Demographics
NPI:1073602157
Name:MATINFAR, FARIBA
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:MATINFAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 11021
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-4521
Mailing Address - Country:US
Mailing Address - Phone:323-528-5153
Mailing Address - Fax:
Practice Address - Street 1:550 E DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3314
Practice Address - Country:US
Practice Address - Phone:310-515-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics