Provider Demographics
NPI:1376704999
Name:KHOURY, FARJALLAH NASSIM I (MD)
Entity Type:Individual
Prefix:
First Name:FARJALLAH
Middle Name:NASSIM
Last Name:KHOURY
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:ANNENBERG WEST 2ND FLOOR
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-834-7870
Mailing Address - Fax:760-834-7871
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:ANNENBERG WEST 2ND FLOOR
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-834-7870
Practice Address - Fax:760-834-7871
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112452208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation