Basic Information
| Provider Information | |||||||||
| NPI: | 1033522404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIRAYESH | ||||||||
| FirstName: | FARNAZ | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BAQAI | ||||||||
| OtherFirstName: | FARNAZ | ||||||||
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| OtherCredential: | D.O | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1400 E. CHURCH STREET | ||||||||
| Address2: | ATTENTION: MEDICAL STAFF OFFICE | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393954 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5075 S BRADLEY RD STE 131 | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934555077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053328155 | ||||||||
| FaxNumber: | 8053328156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2014 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A14362 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.