Provider Demographics
NPI:1083675821
Name:BAHRAMI, FARIDEH FARID (RNP)
Entity Type:Individual
Prefix:
First Name:FARIDEH
Middle Name:FARID
Last Name:BAHRAMI
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:855-206-6764
Mailing Address - Fax:949-923-3575
Practice Address - Street 1:11 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2302
Practice Address - Country:US
Practice Address - Phone:855-206-6764
Practice Address - Fax:949-923-3575
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB226605Medicare PIN
S99584Medicare UPIN
CAGR0095540Medicaid