Basic Information
| Provider Information | |||||||||
| NPI: | 1194289868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FARHAD NIKOO INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5092 CINNAMON | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926122318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499436090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27700 MEDICAL CENTER RD | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493641400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | NIKOO | ||||||||
| AuthorizedOfficialFirstName: | FARHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9499436090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.