Provider Demographics
NPI:1932347697
Name:FARSHID NEJAD, D.P.M. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:FARSHID NEJAD, D.P.M. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-651-0405
Mailing Address - Street 1:11901 SANTA MONICA BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2782
Mailing Address - Country:US
Mailing Address - Phone:323-651-0405
Mailing Address - Fax:310-652-3669
Practice Address - Street 1:11901 SANTA MONICA BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2782
Practice Address - Country:US
Practice Address - Phone:323-651-0405
Practice Address - Fax:310-652-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4525213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99365Medicare UPIN