Provider Demographics
NPI:1962897645
Name:FOOROHAR, AFSOON (DO)
Entity type:Individual
Prefix:
First Name:AFSOON
Middle Name:
Last Name:FOOROHAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 S ELLIOTT PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2224
Mailing Address - Country:US
Mailing Address - Phone:858-774-8638
Mailing Address - Fax:
Practice Address - Street 1:34 MARK WEST SPRINGS RD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1766
Practice Address - Country:US
Practice Address - Phone:707-573-5240
Practice Address - Fax:707-573-5411
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A14940OtherSTATE MEDICAL LICENSE