Provider Demographics
NPI:1821296559
Name:BOLOURCHI, FARIBA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:FARIBA
Middle Name:
Last Name:BOLOURCHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801840
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-1840
Mailing Address - Country:US
Mailing Address - Phone:661-259-4800
Mailing Address - Fax:
Practice Address - Street 1:24510 TOWN CENTER DR
Practice Address - Street 2:# 240
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1337
Practice Address - Country:US
Practice Address - Phone:661-259-4800
Practice Address - Fax:661-259-3955
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice