Provider Demographics
NPI:1215550256
Name:FARJOUDI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FARJOUDI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARJOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-288-8383
Mailing Address - Street 1:29911 NIGUEL RD # 7993
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-2479
Mailing Address - Country:US
Mailing Address - Phone:619-288-8383
Mailing Address - Fax:
Practice Address - Street 1:23521 PASEO DE VALENCIA STE 108
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3137
Practice Address - Country:US
Practice Address - Phone:949-943-3334
Practice Address - Fax:949-943-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty