# G. FAZILAT, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275841223
- **Authorized official:** GOLAREH FAZILAT MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (949) 502-3333

## Contact information

- **Practice address:** 23832 ROCKFIELD BLVD STE 150, LAKE FOREST, CA 92630-2820
- **Practice address phone:** (949) 502-3333
- **Practice address fax:** (949) 229-3685
- **Mailing address:** 23832 ROCKFIELD BLVD STE 150, LAKE FOREST, CA 92630-2820
- **Mailing address phone:** (949) 502-3333
- **Mailing address fax:** (949) 229-3685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | A101403 | CA | Yes |

## Other

- **Enumeration date:** 09/23/2010
- **Last updated:** 02/21/2018