Provider Demographics
NPI:1417375098
Name:FARAG, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FARAG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12400 BLOOMFIELD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4750
Mailing Address - Country:US
Mailing Address - Phone:562-967-2801
Mailing Address - Fax:562-967-2804
Practice Address - Street 1:12400 BLOOMFIELD AVE FL 3
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4750
Practice Address - Country:US
Practice Address - Phone:562-967-2801
Practice Address - Fax:562-967-2804
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2020-11-24
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Provider Licenses
StateLicense IDTaxonomies
CAA1410242084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology