Provider Demographics
NPI:1073027553
Name:FAROKHIAN, NINA (NMD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:FAROKHIAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARISOL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1208
Mailing Address - Country:US
Mailing Address - Phone:630-915-9051
Mailing Address - Fax:
Practice Address - Street 1:23600 ROCKFIELD BLVD STE 2N
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1671
Practice Address - Country:US
Practice Address - Phone:630-915-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND889175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath