Provider Demographics
NPI:1710244462
Name:JALALI, FARID (MD)
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:JALALI
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 1:24221 CALLE DE LA LOUISA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7637
Mailing Address - Country:US
Mailing Address - Phone:949-770-7163
Mailing Address - Fax:949-465-0946
Practice Address - Street 1:24221 CALLE DE LA LOUISA STE 300
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7637
Practice Address - Country:US
Practice Address - Phone:949-770-7163
Practice Address - Fax:949-465-0946
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA129339207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA129339OtherMEDICAL LICENSE