Provider Demographics
NPI:1255384905
Name:FARAHMAND, SHIRIN M (MD)
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:M
Last Name:FARAHMAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749241
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-9241
Mailing Address - Country:US
Mailing Address - Phone:714-992-3907
Mailing Address - Fax:
Practice Address - Street 1:101 E. VALENCIA MESA DR.
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92635
Practice Address - Country:US
Practice Address - Phone:714-992-3148
Practice Address - Fax:714-992-3055
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48578207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485780Medicaid
CAWA48578QMedicare PIN
CAF38063Medicare UPIN
CAAN538ZMedicare PIN
CA00A485780Medicaid