1154344554 NPI number — DR. FARSHIDEH FARA MORSHEDIAN

Table of content: DR. FARSHIDEH FARA MORSHEDIAN (NPI 1154344554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154344554 NPI number — DR. FARSHIDEH FARA MORSHEDIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORSHEDIAN
Provider First Name:
FARSHIDEH
Provider Middle Name:
FARA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154344554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
281E COLORADO BLVD 1003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91102-7047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-780-3427
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 N SUNSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COVINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91790-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-257-8715
Provider Business Practice Location Address Fax Number:
800-819-1655
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY12112 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0PL121120 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 680009853 . This is a "RAIL ROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PSY121120 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".