Provider Demographics
NPI:1073962171
Name:FARIED BANIMAHD MD INC
Entity Type:Organization
Organization Name:FARIED BANIMAHD MD INC
Other - Org Name:SOUTH COUNTY ADDICTION AND TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL AND EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIED
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIMAHD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-305-8910
Mailing Address - Street 1:1835 NEWPORT BLVD STE A109-559
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5031
Mailing Address - Country:US
Mailing Address - Phone:949-347-8721
Mailing Address - Fax:949-347-8709
Practice Address - Street 1:1533 E 4TH ST STE 4
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5115
Practice Address - Country:US
Practice Address - Phone:949-347-8721
Practice Address - Fax:949-347-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty