Provider Demographics
NPI:1790703643
Name:FARSHIDI, ARDESHIR (MD)
Entity Type:Individual
Prefix:
First Name:ARDESHIR
Middle Name:
Last Name:FARSHIDI
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 1:1000 NEWBURY RD
Mailing Address - Street 2:180
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6435
Mailing Address - Country:US
Mailing Address - Phone:805-449-9990
Mailing Address - Fax:805-449-9993
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:180
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-449-9990
Practice Address - Fax:805-449-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40124207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401240Medicaid
CA954233529OtherEIN
CAA40124Medicare ID - Type Unspecified
CAA40124Medicare PIN
CA954233529OtherEIN