Provider Demographics
NPI:1952556607
Name:FOROUZAN, FARIBA
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:FOROUZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 COHASSET RD
Mailing Address - Street 2:STE 170
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1315
Mailing Address - Country:US
Mailing Address - Phone:530-897-9040
Mailing Address - Fax:
Practice Address - Street 1:2471 COHASSET RD
Practice Address - Street 2:STE 170
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1315
Practice Address - Country:US
Practice Address - Phone:530-897-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist