Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 496 | PR |
N | 152W00000X | Optometrist | 496-302 | PR |
NPI | 1003887522 |
---|---|
Provider Name | Dr. Farzad A. Khazraee |
First Address | Aguadilla, PR 00603-9495 |
Second Address | Isabela, PR 00662-5909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 09/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
HSS378A | (05) | PR |