Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A103643 | CA |
NPI | 1245319375 |
---|---|
Provider Name | Fardad Baroumand |
First Address | Los Gatos, CA 95032-2054 |
Second Address | Los Gatos, CA 95032-2054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 22/12/2011 |