Provider Demographics
NPI:1144416942
Name:FARSHAD J NOSRATIAN M D INC
Entity Type:Organization
Organization Name:FARSHAD J NOSRATIAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NOSRATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:310-679-9999
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90251-0215
Mailing Address - Country:US
Mailing Address - Phone:310-679-9999
Mailing Address - Fax:310-679-0000
Practice Address - Street 1:11726 GREVILLEA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2223
Practice Address - Country:US
Practice Address - Phone:310-679-9999
Practice Address - Fax:310-679-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53751207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G537511Medicaid
CA00G537511Medicaid
CAG53751Medicare PIN