Provider Demographics
NPI:1902037427
Name:FARZANMEHR, HALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:HALEH
Middle Name:
Last Name:FARZANMEHR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18201 MCDURMOTT W
Mailing Address - Street 2:STE B
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4748
Mailing Address - Country:US
Mailing Address - Phone:703-371-6707
Mailing Address - Fax:949-527-6525
Practice Address - Street 1:18201 MCDURMOTT W
Practice Address - Street 2:STE B
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4748
Practice Address - Country:US
Practice Address - Phone:703-371-6707
Practice Address - Fax:949-527-6525
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112919207SM0001X, 207ZP0102X
CACLF00345153291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801226543Medicaid