Provider Demographics
NPI:1164824249
Name:GHORBANIFARAJZADEH, ALI (DPM)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:GHORBANIFARAJZADEH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 PARK SQUARE DR APT D204
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8854
Mailing Address - Country:US
Mailing Address - Phone:305-310-8155
Mailing Address - Fax:661-322-6249
Practice Address - Street 1:500 OLD RIVER RD STE 185
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9505
Practice Address - Country:US
Practice Address - Phone:661-832-3600
Practice Address - Fax:661-322-6249
Is Sole Proprietor?:No
Enumeration Date:2014-09-21
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5332213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery