Provider Demographics
NPI:1629107636
Name:FARID YASHARPOUR M.D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FARID YASHARPOUR M.D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-270-9030
Mailing Address - Street 1:14671 RINALDI ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4199
Mailing Address - Country:US
Mailing Address - Phone:818-270-9030
Mailing Address - Fax:818-270-9039
Practice Address - Street 1:14671 RINALDI ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4199
Practice Address - Country:US
Practice Address - Phone:818-270-9030
Practice Address - Fax:818-270-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH60183Medicare UPIN