Provider Demographics
NPI:1902010937
Name:DAVIDI, FARAMARZ (MD)
Entity Type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:DAVIDI
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 1:16260 VENTURA BLVD
Mailing Address - Street 2:SUITE # 830
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2203
Mailing Address - Country:US
Mailing Address - Phone:818-990-8008
Mailing Address - Fax:818-990-5030
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE # 830
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-990-8008
Practice Address - Fax:818-990-5030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051024207W00000X, 2086S0122X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A510244Medicaid
CAF52090Medicare UPIN
CAA51024Medicare ID - Type Unspecified