Provider Demographics
NPI:1316603483
Name:FARZAM, STEVE (JD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:FARZAM
Suffix:
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SANTA MONICA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2624
Mailing Address - Country:US
Mailing Address - Phone:888-878-9111
Mailing Address - Fax:
Practice Address - Street 1:701 SANTA MONICA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2624
Practice Address - Country:US
Practice Address - Phone:888-878-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2214309291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory