Provider Demographics
NPI:1922357821
Name:REZA FAROKHPAY MD INC APC
Entity Type:Organization
Organization Name:REZA FAROKHPAY MD INC APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROKHPAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-929-5984
Mailing Address - Street 1:P.O. BOX 2089
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-2089
Mailing Address - Country:US
Mailing Address - Phone:714-940-0941
Mailing Address - Fax:714-940-0944
Practice Address - Street 1:10802 COLLEGE PLACE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1505
Practice Address - Country:US
Practice Address - Phone:714-940-0941
Practice Address - Fax:714-940-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1080972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1080970Medicaid
CA0A1080970Medicaid