| Azita Fakheri Md Inc | |
|
19100 Ventura Blvd Ste A Tarzana CA 91356-3238 | |
| (818) 343-0101 | |
| (818) 343-0269 |
| Full Name | Azita Fakheri Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 19100 Ventura Blvd Ste A, Tarzana, California |
| Authorized Official Name and Position | Azita Fakheri (OWNER) |
| Authorized Official Contact | 8183430101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azita Fakheri Md Inc 18060 Lake Encino Dr Encino CA 91316-4432 Ph: (818) 343-0101 | Azita Fakheri Md Inc 19100 Ventura Blvd Ste A Tarzana CA 91356-3238 Ph: (818) 343-0101 |
| NPI Number | 1558556696 |
|---|---|
| Provider Enumeration Date | 09/12/2007 |
| Last Update Date | 01/02/2020 |
| Medicare PECOS PAC ID | 1759360753 |
|---|---|
| Medicare Enrollment ID | O20040714001002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558556696 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A69052 (California) | Primary |
| Provider Name | Azita Fakheri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669410270 PECOS PAC ID: 8820077837 Enrollment ID: I20040714001061 |
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