Provider Demographics
NPI:1154467561
Name:ABDUL S. FARZIN M.D., INC
Entity Type:Organization
Organization Name:ABDUL S. FARZIN M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-600-0640
Mailing Address - Street 1:36243 INLAND VALLEY DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9549
Mailing Address - Country:US
Mailing Address - Phone:951-600-0640
Mailing Address - Fax:951-600-8142
Practice Address - Street 1:36243 INLAND VALLEY DR
Practice Address - Street 2:SUITE 240
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9549
Practice Address - Country:US
Practice Address - Phone:951-600-0640
Practice Address - Fax:951-600-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53334OtherSTATE LICENSE
CABF4088921OtherDEA NUMBER
CAG01198Medicare UPIN