Provider Demographics
NPI:1831277946
Name:FARHIDVASH, FARIBA (MD, MPH)
Entity type:Individual
Prefix:
First Name:FARIBA
Middle Name:
Last Name:FARHIDVASH
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44045 MARGARITA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2729
Mailing Address - Country:US
Mailing Address - Phone:951-462-4624
Mailing Address - Fax:951-462-4625
Practice Address - Street 1:44045 MARGARITA RD STE 106
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2729
Practice Address - Country:US
Practice Address - Phone:951-462-4624
Practice Address - Fax:951-462-4625
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0535202084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA586993320EMedicaid
13BDFFBMedicare PIN
GA586993320DMedicaid
GA586993320CMedicaid
GA52212528OtherBCBS