Provider Demographics
NPI:1700417755
Name:FARANAK GHAZI MD
Entity Type:Organization
Organization Name:FARANAK GHAZI MD
Other - Org Name:OPTIMAL HEALTH PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:FARANAK
Authorized Official - Middle Name:CHLOE
Authorized Official - Last Name:GHAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-456-2471
Mailing Address - Street 1:1625 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5223
Mailing Address - Country:US
Mailing Address - Phone:619-456-2471
Mailing Address - Fax:
Practice Address - Street 1:1625 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5223
Practice Address - Country:US
Practice Address - Phone:619-456-2471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty