Provider Demographics
NPI:1194969436
Name:MIRZAEE, FARSHID (MD)
Entity type:Individual
Prefix:DR
First Name:FARSHID
Middle Name:
Last Name:MIRZAEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72650 FRED WARING DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-5007
Mailing Address - Country:US
Mailing Address - Phone:760-346-1133
Mailing Address - Fax:760-346-8857
Practice Address - Street 1:39000 BOB HOPE DRIVE PROBST 303
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-346-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130876208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology