Provider Demographics
NPI:1902909807
Name:E. ISAAC FARAJI MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:E. ISAAC FARAJI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ESHAGH
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:FARAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-667-0543
Mailing Address - Street 1:PO BOX 3166
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-3166
Mailing Address - Country:US
Mailing Address - Phone:209-667-0543
Mailing Address - Fax:209-667-0613
Practice Address - Street 1:1729 N. OLIVE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-667-0543
Practice Address - Fax:209-667-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty