Provider Demographics
NPI:1922035781
Name:GHOSHEH, FARIS R (MD)
Entity Type:Individual
Prefix:
First Name:FARIS
Middle Name:R
Last Name:GHOSHEH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26701 CROWN VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6356
Mailing Address - Country:US
Mailing Address - Phone:949-582-1090
Mailing Address - Fax:949-582-2862
Practice Address - Street 1:26701 CROWN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6356
Practice Address - Country:US
Practice Address - Phone:949-582-1090
Practice Address - Fax:949-582-2862
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-11-07
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Provider Licenses
StateLicense IDTaxonomies
CAA86170207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA86170AMedicare PIN