Provider Demographics
NPI:1437144599
Name:MASSOUDI, FARZAD (MD)
Entity Type:Individual
Prefix:
First Name:FARZAD
Middle Name:
Last Name:MASSOUDI
Suffix:
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 1:23961 CALLE DE LA MAGDALENA STE 405
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3683
Mailing Address - Country:US
Mailing Address - Phone:949-588-5800
Mailing Address - Fax:949-380-3344
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 405
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3683
Practice Address - Country:US
Practice Address - Phone:949-588-5800
Practice Address - Fax:949-380-3344
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76503207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF70477Medicare UPIN