Provider Demographics
NPI:1205161932
Name:ABDOLLAHI-FARD, ALIREZA
Entity type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:ABDOLLAHI-FARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7152 N SHARON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3361
Mailing Address - Country:US
Mailing Address - Phone:559-432-6807
Mailing Address - Fax:
Practice Address - Street 1:7152 N SHARON AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3361
Practice Address - Country:US
Practice Address - Phone:559-432-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110374207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01533542Medicare PIN
CACA132125Medicare PIN