Provider Demographics
NPI:1639290075
Name:MOZAFFARI, FARID BRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARID
Middle Name:BRAD
Last Name:MOZAFFARI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7770 REGENTS RD 113
Mailing Address - Street 2:#400
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-453-8484
Mailing Address - Fax:858-453-3284
Practice Address - Street 1:4520 EXECUTIVE DR
Practice Address - Street 2:STE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-456-8484
Practice Address - Fax:858-453-3284
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA57899208600000X
WV223242086S0122X
FL164717208200000X
CAC156516208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4241281Medicare PIN