Provider Demographics
NPI:1245319375
Name:BAROUMAND, FARDAD (MD)
Entity type:Individual
Prefix:
First Name:FARDAD
Middle Name:
Last Name:BAROUMAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FARDAD
Other - Middle Name:
Other - Last Name:BAROUMAND SHAMSALDINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15047 LOS GATOS BLVD
Mailing Address - Street 2:STE.200
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2054
Mailing Address - Country:US
Mailing Address - Phone:408-364-6799
Mailing Address - Fax:408-378-4510
Practice Address - Street 1:15047 LOS GATOS BLVD
Practice Address - Street 2:STE.200
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2054
Practice Address - Country:US
Practice Address - Phone:408-364-6799
Practice Address - Fax:408-378-4510
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1036432081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine