Provider Demographics
NPI:1871529297
Name:FARROKH ALEMZADEH M D INC
Entity type:Organization
Organization Name:FARROKH ALEMZADEH M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-654-4325
Mailing Address - Street 1:655 CAMINO DE LOS MARES STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2809
Mailing Address - Country:US
Mailing Address - Phone:949-654-4325
Mailing Address - Fax:949-654-8730
Practice Address - Street 1:655 CAMINO DE LOS MARES STE 207
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2809
Practice Address - Country:US
Practice Address - Phone:949-654-4325
Practice Address - Fax:949-654-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA55448OtherSTATE LICENSE
CAPCP 1203OtherMONARCH HEALTH CARE
CAZZZ67835ZOtherBLUE SHIELD
CAZZZ67836ZOtherBLUE SHIELD
CAPCP 1203OtherMONARCH HEALTH CARE
CAW17247Medicare ID - Type UnspecifiedGROUP PROVIDER