Provider Demographics
NPI:1992311278
Name:KARGARAN, FARNAZ
Entity type:Individual
Prefix:
First Name:FARNAZ
Middle Name:
Last Name:KARGARAN
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 1:13881 CARMEL VALLEY RD APT 122
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5637
Mailing Address - Country:US
Mailing Address - Phone:408-409-0883
Mailing Address - Fax:
Practice Address - Street 1:13460 HIGHLANDS PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2401
Practice Address - Country:US
Practice Address - Phone:858-755-7593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist