Provider Demographics
NPI:1902984883
Name:GHIAI FATEMI, AFSHAN (MD)
Entity Type:Individual
Prefix:
First Name:AFSHAN
Middle Name:
Last Name:GHIAI FATEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 N VENTURA RD STE 100
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1126
Practice Address - Country:US
Practice Address - Phone:805-981-6101
Practice Address - Fax:805-981-6201
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70771207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A707710Medicaid
H53588Medicare UPIN
BG6758998OtherDEA
H53588Medicare UPIN
WA70771BMedicare ID - Type Unspecified