Provider Demographics
NPI:1922401215
Name:ELAHEH FARHADIAN MD INC.
Entity Type:Organization
Organization Name:ELAHEH FARHADIAN MD INC.
Other - Org Name:DR. ELIE MEDICAL CENTER INTERNAL MEDICINE & COSMETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELAHEH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-923-5702
Mailing Address - Street 1:17447 CHATSWORTH STREET
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-923-5702
Mailing Address - Fax:818-923-5703
Practice Address - Street 1:17447 CHATSWORTH STREET
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344
Practice Address - Country:US
Practice Address - Phone:818-923-5702
Practice Address - Fax:818-923-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA100453OtherMEDICAL LICENSE