Provider Demographics
NPI:1326822768
Name:FARIDI, DAVID (CNMT, CT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FARIDI
Suffix:
Gender:M
Credentials:CNMT, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 EL FAISAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4517
Mailing Address - Country:US
Mailing Address - Phone:714-348-2789
Mailing Address - Fax:
Practice Address - Street 1:18511 MISSION VIEW DR STE 120
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2975
Practice Address - Country:US
Practice Address - Phone:714-348-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHN000034502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology