Provider Demographics
NPI:1376972331
Name:MARVASTI MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MARVASTI MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FANI MARVASTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-924-5150
Mailing Address - Street 1:PO BOX 8468
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-8468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6927 E QUAIL RUN RD
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5350
Practice Address - Country:US
Practice Address - Phone:650-924-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-10
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty