Provider Demographics
NPI:1699462804
Name:KHOSRAVIANI, FARSHAD
Entity type:Individual
Prefix:
First Name:FARSHAD
Middle Name:
Last Name:KHOSRAVIANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 1/2 S SHERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3214
Mailing Address - Country:US
Mailing Address - Phone:949-771-5704
Mailing Address - Fax:
Practice Address - Street 1:71949 HIGHWAY 111 STE 100B
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4826
Practice Address - Country:US
Practice Address - Phone:760-565-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program