Provider Demographics
NPI:1144301748
Name:AFRA, FARID (MD)
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:AFRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TROUSDALE PL
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1904
Mailing Address - Country:US
Mailing Address - Phone:310-859-0416
Mailing Address - Fax:310-474-4700
Practice Address - Street 1:450 TROUSDALE PL
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1904
Practice Address - Country:US
Practice Address - Phone:310-859-0416
Practice Address - Fax:310-474-4700
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA334032086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33403Medicare ID - Type UnspecifiedMEDICARE