Provider Demographics
NPI:1750723698
Name:FARAJI, BAHRAM (RD, LD, DRPH)
Entity type:Individual
Prefix:DR
First Name:BAHRAM
Middle Name:
Last Name:FARAJI
Suffix:
Gender:M
Credentials:RD, LD, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 TORI LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6044
Mailing Address - Country:US
Mailing Address - Phone:956-739-7790
Mailing Address - Fax:
Practice Address - Street 1:1021 TORI LN
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6044
Practice Address - Country:US
Practice Address - Phone:956-739-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 133VN1006X
TXDT04679133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic