Provider Demographics
NPI:1891971131
Name:SAMY F FARID MD FACOG MRCOG INC
Entity Type:Organization
Organization Name:SAMY F FARID MD FACOG MRCOG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:FARID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-949-5193
Mailing Address - Street 1:1729 WEST AVE J
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4014
Mailing Address - Country:US
Mailing Address - Phone:661-949-5193
Mailing Address - Fax:661-949-6948
Practice Address - Street 1:1729 W AVE J
Practice Address - Street 2:101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4014
Practice Address - Country:US
Practice Address - Phone:661-949-5193
Practice Address - Fax:661-949-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A453902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453902Medicaid