Provider Demographics
NPI:1255408282
Name:FARINPOUR, ROXANNA (PHD)
Entity type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:
Last Name:FARINPOUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73255 EL PASEO
Mailing Address - Street 2:STE 6
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-341-8878
Mailing Address - Fax:760-341-8820
Practice Address - Street 1:73255 EL PASEO
Practice Address - Street 2:STE 6
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-341-8878
Practice Address - Fax:760-341-8820
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16773103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255408282OtherNPI NUMBER
CAPSY16773OtherSTATE LICENSE
CAAQ859ZOtherMEDICARE PTAN #