Individual
FARIBORZ LALEZARZADEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
164 W HOSPITALITY LN STE 100, SAN BERNARDINO, CA 92408-3316
(909) 883-8834
(909) 644-4021
Mailing address
700 E REDLANDS BLVD STE U506, REDLANDS, CA 92373-6109
(909) 883-8834
(909) 883-8834
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A8309
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020A83090
MEDICARE ID TYPE UNSPECIFIED
CA
05
—
020A83090
—
CA
05
—
GR0079700
—
CA
Enumeration date
08/25/2006
Last updated
11/08/2022
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