Provider Demographics
NPI:1104077726
Name:FARHADI, PANTEA (MD)
Entity type:Individual
Prefix:MRS
First Name:PANTEA
Middle Name:
Last Name:FARHADI
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 1:8581 SANTA MONICA BLVD # 137
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4120
Mailing Address - Country:US
Mailing Address - Phone:310-890-7598
Mailing Address - Fax:
Practice Address - Street 1:8635 WEST 3RD STREET
Practice Address - Street 2:SUITE W 1065
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-890-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1050572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105057Medicaid
CAA105057Medicaid