Basic Information
| Provider Information | |||||||||
| NPI: | 1922035781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHOSHEH | ||||||||
| FirstName: | FARIS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26701 CROWN VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495821090 | ||||||||
| FaxNumber: | 9495822862 | ||||||||
| Practice Location | |||||||||
| Address1: | 26701 CROWN VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495821090 | ||||||||
| FaxNumber: | 9495822862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 11/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | A86170 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.