Provider Demographics
NPI:1750575213
Name:AKHAVON, FARIBA (MD)
Entity type:Individual
Prefix:
First Name:FARIBA
Middle Name:
Last Name:AKHAVON
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 1:316 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6232
Mailing Address - Country:US
Mailing Address - Phone:559-688-8880
Mailing Address - Fax:559-688-8877
Practice Address - Street 1:316 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6232
Practice Address - Country:US
Practice Address - Phone:559-688-8880
Practice Address - Fax:559-688-8877
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA112198OtherLICENSE