Provider Demographics
NPI:1700294386
Name:FARSHAD NOWZARI, MD INC
Entity Type:Organization
Organization Name:FARSHAD NOWZARI, MD INC
Other - Org Name:SOCAL ADVANCED UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWZARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-538-2930
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE #303
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-538-2930
Mailing Address - Fax:310-538-2932
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE #303
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3586
Practice Address - Country:US
Practice Address - Phone:310-538-2930
Practice Address - Fax:310-538-2932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARSHAD NOWZARI, MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75966208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH554343Medicare UPIN