Provider Demographics
NPI:1093934200
Name:MEMARZADEH, FARNAZ (MD)
Entity type:Individual
Prefix:
First Name:FARNAZ
Middle Name:
Last Name:MEMARZADEH
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 1:1450 SAN PABLO ST
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5331
Mailing Address - Country:US
Mailing Address - Phone:323-442-7158
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO ST
Practice Address - Street 2:SUITE #4000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5331
Practice Address - Country:US
Practice Address - Phone:323-442-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79896207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A798960OtherBLUE SHIELD
CA00A798960Medicaid
CA00A798960Medicare PIN
CAI44055Medicare UPIN
CAWA79896BMedicare PIN
CA00A798960Medicaid
CAWA79896CMedicare PIN
CAWA79896AMedicare PIN