Provider Demographics
NPI:1801104179
Name:FATHI, ROYA (MD)
Entity type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:FATHI
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 1:28901 CANMORE ST
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1716
Mailing Address - Country:US
Mailing Address - Phone:312-351-0420
Mailing Address - Fax:
Practice Address - Street 1:28901 CANMORE ST
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1716
Practice Address - Country:US
Practice Address - Phone:312-351-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124602207RG0300X
DEC12-0000037207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801104179OtherNPI