Provider Demographics
NPI:1750920153
Name:SOORENA FATEHCHEHR MD INC
Entity type:Organization
Organization Name:SOORENA FATEHCHEHR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SOORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATEHCHEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-869-3212
Mailing Address - Street 1:4250 GLENCOE AVE UNIT 1114
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5660
Mailing Address - Country:US
Mailing Address - Phone:310-869-3212
Mailing Address - Fax:949-502-8887
Practice Address - Street 1:529 E 10TH ST FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4508
Practice Address - Country:US
Practice Address - Phone:562-491-9047
Practice Address - Fax:562-491-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty