Provider Demographics
NPI:1679916019
Name:GOUSSE, FERISHTA (MD)
Entity Type:Individual
Prefix:
First Name:FERISHTA
Middle Name:
Last Name:GOUSSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FERISHTA
Other - Middle Name:
Other - Last Name:NAWABI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1945 N FINE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1528
Mailing Address - Country:US
Mailing Address - Phone:559-457-5650
Mailing Address - Fax:559-457-5695
Practice Address - Street 1:1945 N FINE AVE STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1528
Practice Address - Country:US
Practice Address - Phone:559-457-5650
Practice Address - Fax:559-457-5695
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54779207Q00000X
CAA149004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine