Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 99160 | CA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 99160 | CA |
NPI | 1124295027 |
---|---|
Provider Name | Dr. Farshad Raissi Shabari |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2008 |
Last Update Date | 27/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W13536 | (05) | CA |