Provider Demographics
NPI:1598739120
Name:POURGHASEMI, FARANAK
Entity Type:Individual
Prefix:
First Name:FARANAK
Middle Name:
Last Name:POURGHASEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18817 MARTHA AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4641
Mailing Address - Country:US
Mailing Address - Phone:510-432-8864
Mailing Address - Fax:
Practice Address - Street 1:14981 NATIONAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2600
Practice Address - Country:US
Practice Address - Phone:408-884-5851
Practice Address - Fax:408-884-1503
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4658213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery