Provider Demographics
NPI:1215251822
Name:FARJOUDI, FARHAD (MD)
Entity type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:FARJOUDI
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 1:29911 NIGUEL RD
Mailing Address - Street 2:UNIT 7693
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-2471
Mailing Address - Country:US
Mailing Address - Phone:614-288-8383
Mailing Address - Fax:
Practice Address - Street 1:5555 RESERVOIR DR
Practice Address - Street 2:STE 312
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5173
Practice Address - Country:US
Practice Address - Phone:619-269-1296
Practice Address - Fax:619-639-7286
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123543207R00000X, 208M00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist