Provider Demographics
NPI:1285709725
Name:FIROOZNAM, POPAK
Entity type:Individual
Prefix:
First Name:POPAK
Middle Name:
Last Name:FIROOZNAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8636 E CANYON VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1620
Mailing Address - Country:US
Mailing Address - Phone:909-469-9494
Mailing Address - Fax:
Practice Address - Street 1:1770 N ORANGE GROVE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3027
Practice Address - Country:US
Practice Address - Phone:909-469-9494
Practice Address - Fax:909-865-2982
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine