Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A100516 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | A100516 | CA |
NPI | 1184860496 |
---|---|
Provider Name | Dr. Faried Banimahd |
First Address | Costa Mesa, CA 92627-5031 |
Second Address | Santa Ana, CA 92701-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2008 |
Last Update Date | 14/02/2020 |