Provider Demographics
NPI:1508825027
Name:ALAV, FARAMARZ (MD)
Entity Type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:ALAV
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 1:16465 SIERRA LAKES PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1242
Mailing Address - Country:US
Mailing Address - Phone:909-429-2404
Mailing Address - Fax:909-429-2030
Practice Address - Street 1:16465 SIERRA LAKES PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1242
Practice Address - Country:US
Practice Address - Phone:909-429-2404
Practice Address - Fax:909-429-2030
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A74030Medicaid
CA00A74030Medicaid