Provider Demographics
NPI:1992985923
Name:LAMORINDA ENT FACE & NECK SURGERY INC
Entity type:Organization
Organization Name:LAMORINDA ENT FACE & NECK SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTOLARYNGOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALSAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-299-9919
Mailing Address - Street 1:911 MORAGA ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549
Mailing Address - Country:US
Mailing Address - Phone:925-299-9919
Mailing Address - Fax:925-299-9924
Practice Address - Street 1:911 MORAGA ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4591
Practice Address - Country:US
Practice Address - Phone:925-299-9919
Practice Address - Fax:925-299-9924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAMORINDA ENT FACE & NECK SURGERY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-07
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85934207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty