Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | RESIDENT | NM |
NPI | 1093335473 |
---|---|
Provider Name | Seyed Faraz Heydari |
First Address | Pleasant Hill, CA 94523-3317 |
Second Address | Albuquerque, NM 87108-5180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2020 |
Last Update Date | 25/04/2020 |