Provider Demographics
NPI:1598196396
Name:FARIBA AKHAVON MD PC
Entity Type:Organization
Organization Name:FARIBA AKHAVON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-688-8880
Mailing Address - Street 1:316 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6232
Mailing Address - Country:US
Mailing Address - Phone:559-688-8880
Mailing Address - Fax:559-688-8877
Practice Address - Street 1:316 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6232
Practice Address - Country:US
Practice Address - Phone:559-688-8880
Practice Address - Fax:559-688-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA112198OtherMEDICAL LICENSE NUMBER
CAA112198OtherMEDICAL LICENSE NUMBER