Individual
DR. FARROKH SHADAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11180 WARNER AVE, SUITE 169, FOUNTAIN VALLEY, CA 92708-7501
(714) 549-1200
(714) 549-3238
Mailing address
11180 WARNER AVE, SUITE 169, FOUNTAIN VALLEY, CA 92708-7501
(714) 549-1200
(714) 549-3238
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A33729
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A337290
—
CA
01
—
00A37290
BLUE CROSS BLUE SHIELD
CA
Enumeration date
07/16/2006
Last updated
07/08/2007
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