Provider Demographics
NPI:1346268919
Name:SERAJ, FARIBA (NP/PA)
Entity Type:Individual
Prefix:MRS
First Name:FARIBA
Middle Name:
Last Name:SERAJ
Suffix:
Gender:F
Credentials:NP/PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N PROSPECT AVE
Mailing Address - Street 2:SUITE 302,
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3041
Mailing Address - Country:US
Mailing Address - Phone:310-798-1515
Mailing Address - Fax:310-798-3131
Practice Address - Street 1:520 N PROSPECT AVE
Practice Address - Street 2:SUITE 302,
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3041
Practice Address - Country:US
Practice Address - Phone:310-798-1515
Practice Address - Fax:310-798-3131
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327511363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14911Medicare PIN