Provider Demographics
NPI:1184860496
Name:BANIMAHD, FARIED (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIED
Middle Name:
Last Name:BANIMAHD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 NEWPORT BLVD STE A109-559
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5031
Mailing Address - Country:US
Mailing Address - Phone:949-347-8721
Mailing Address - Fax:949-347-8709
Practice Address - Street 1:1533 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5115
Practice Address - Country:US
Practice Address - Phone:949-347-8721
Practice Address - Fax:949-347-8709
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100516207RA0401X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine