Provider Demographics
NPI:1326265422
Name:FARAJZADEH, FARSHID (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:FARSHID
Middle Name:
Last Name:FARAJZADEH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 MISSION BAY DR
Mailing Address - Street 2:STE 3K
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4926
Mailing Address - Country:US
Mailing Address - Phone:858-531-3700
Mailing Address - Fax:858-866-0342
Practice Address - Street 1:4501 MISSION BAY DR STE 3K
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4926
Practice Address - Country:US
Practice Address - Phone:858-866-0340
Practice Address - Fax:858-866-0342
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT20075OtherPHYSCIAL THERAPY LIC #
CAPT20075OtherPHYSCIAL THERAPY LIC #
CAPT20075OtherPHYSCIAL THERAPY LIC #