Provider Demographics
NPI:1639253396
Name:NOSRATIAN, FARSHAD JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:FARSHAD
Middle Name:JOSEPH
Last Name:NOSRATIAN
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90251
Mailing Address - Country:US
Mailing Address - Phone:310-679-9999
Mailing Address - Fax:310-679-0000
Practice Address - Street 1:4477 W 118TH STREET
Practice Address - Street 2:SUITE 501
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-679-9999
Practice Address - Fax:310-679-0000
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53751207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G537511Medicaid
CAG53751Medicare ID - Type Unspecified
CA00G537511Medicaid