Provider Demographics
NPI:1891767935
Name:SAADAT, FARID (MD)
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:SAADAT
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 1:425 DIAMOND DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4561
Mailing Address - Country:US
Mailing Address - Phone:951-471-5711
Mailing Address - Fax:951-471-5713
Practice Address - Street 1:425 DIAMOND DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4561
Practice Address - Country:US
Practice Address - Phone:951-471-5711
Practice Address - Fax:951-471-5713
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A497820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A497820Medicaid
CAF76177Medicare UPIN
CA00A497820Medicare ID - Type Unspecified