Provider Demographics
NPI:1801322516
Name:TALEBI LIASI, FAEZEH (MD)
Entity type:Individual
Prefix:
First Name:FAEZEH
Middle Name:
Last Name:TALEBI LIASI
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 1:36867 COOK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6064
Mailing Address - Country:US
Mailing Address - Phone:760-341-1999
Mailing Address - Fax:
Practice Address - Street 1:1620 E 2ND ST STE N
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-845-6500
Practice Address - Fax:866-859-0338
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300671208D00000X
CAA159670207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice