Provider Demographics
NPI:1245055151
Name:MUTAHIR FARHAN MEDICAL CORPORATION
Entity type:Organization
Organization Name:MUTAHIR FARHAN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DARIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-728-7877
Mailing Address - Street 1:20810 BAKAL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2983
Mailing Address - Country:US
Mailing Address - Phone:951-497-3749
Mailing Address - Fax:954-405-8701
Practice Address - Street 1:284 DUPONT ST STE 130
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6029
Practice Address - Country:US
Practice Address - Phone:951-497-3749
Practice Address - Fax:954-405-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty