1780751693 NPI number — DR. FARROUKH AJIR MD

Table of content: MARVIN FLORES ROMAN M.D. (NPI 1699960245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780751693 NPI number — DR. FARROUKH AJIR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AJIR
Provider First Name:
FARROUKH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AJIR
Provider Other First Name:
FARR
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780751693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3448 WHITERIVER PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-879-9348
Provider Business Mailing Address Fax Number:
818-879-9358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 WESTLAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE #121
Provider Business Practice Location Address City Name:
WESTLAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-879-9348
Provider Business Practice Location Address Fax Number:
818-879-9358
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  A37062 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A370620 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10629 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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