Provider Demographics
NPI:1144802380
Name:FARMANIAN, ALIREZA
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:FARMANIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 POTOMAC
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3255
Mailing Address - Country:US
Mailing Address - Phone:949-537-9434
Mailing Address - Fax:
Practice Address - Street 1:211 W BIRCH ST
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2348
Practice Address - Country:US
Practice Address - Phone:760-768-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist