Fares Elghazi MD Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

C042219 Issued in CA

Legal business name

FARES ELGHAZI MD MEDICAL CORPORATION

Practice address

1818 N Orange Grove Ave
Suite 300
Pomona, CA 91767-3028

Phone

(909) 620-7876

Fax

(909) 463-2434

NPI assigned

May 12, 2010

Last updated

Jun 18, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fares Elghazi, M.D.

Title

Owner

Phone

(909) 620-7876

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276819200000",
    "number": "1396063574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 N ORANGE GROVE AVE",
            "address_2": "SUITE 300",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673028",
            "telephone_number": "909-620-7876",
            "fax_number": "909-463-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N ORANGE GROVE AVE",
            "address_2": "SUITE 300",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673028",
            "telephone_number": "909-620-7876",
            "fax_number": "909-463-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARES ELGHAZI MD MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-12",
        "last_updated": "2010-06-18",
        "status": "A",
        "authorized_official_last_name": "ELGHAZI",
        "authorized_official_first_name": "FARES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-620-7876",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "C042219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C422190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dache Markes Fance
• William Fang
• Sandra Maurice Farah Franco, DDS
• Matthew Farah, BCBA
• Blake Habib Fardanesh
• Adilene Farias
• Ryan Farid
• Joanne Mary Farley, P.T.
• Nancy Farrell, PSYD DRPH
• Carolyn Fasakin

• Specialist in Pomona, CA
• Providers in Pomona, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.