Provider Demographics
NPI:1194826909
Name:TABRIZI, FARZANEH (MD)
Entity type:Individual
Prefix:
First Name:FARZANEH
Middle Name:
Last Name:TABRIZI
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 1:16400 LARK AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2547
Mailing Address - Country:US
Mailing Address - Phone:408-356-1199
Mailing Address - Fax:408-356-5344
Practice Address - Street 1:16400 LARK AVE
Practice Address - Street 2:STE 300
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2547
Practice Address - Country:US
Practice Address - Phone:408-356-1199
Practice Address - Fax:408-356-5344
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A647170Medicaid
CA00A647171Medicare ID - Type Unspecified
CA00A647170Medicaid