Provider Demographics
NPI:1932380219
Name:MONFARED, MARJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:
Last Name:MONFARED
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 1:21821 LANAR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1041
Mailing Address - Country:US
Mailing Address - Phone:949-380-1234
Mailing Address - Fax:
Practice Address - Street 1:26730 TOWNE CENTRE DR STE 102
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2857
Practice Address - Country:US
Practice Address - Phone:949-380-1234
Practice Address - Fax:949-305-2230
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96525146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant