Provider Demographics
NPI:1730649799
Name:NIAMEDIC BH PC
Entity Type:Organization
Organization Name:NIAMEDIC BH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHBAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-364-2633
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 330
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3633
Mailing Address - Country:US
Mailing Address - Phone:833-364-2633
Mailing Address - Fax:833-364-2633
Practice Address - Street 1:24411 HEALTH CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3633
Practice Address - Country:US
Practice Address - Phone:833-364-2633
Practice Address - Fax:833-364-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty