Provider Demographics
NPI:1306156054
Name:CHAFI, FARIBORZ (LSA)
Entity type:Individual
Prefix:
First Name:FARIBORZ
Middle Name:
Last Name:CHAFI
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21706 FIREMIST WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3520
Mailing Address - Country:US
Mailing Address - Phone:281-859-5268
Mailing Address - Fax:
Practice Address - Street 1:21706 FIREMIST WAY
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3520
Practice Address - Country:US
Practice Address - Phone:281-859-5268
Practice Address - Fax:281-859-5268
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00497246ZC0007X, 246ZC0007X
363AS0400X
TX119805246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00497OtherTEXAS MEDICAL BOARD
TX8NE168OtherBCBS - XCITE SURGICAL
TX8NP660OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX8QF486OtherBCBS - BLUE STAR SURGICAL
TXSA00497OtherTEXAS MEDICAL BOARD
TX8XP792OtherBCBS - US MSO