Fariborz David Massoudi

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHY45471 Issued in CA

Practice address

891 W 9TH St
San Pedro, CA 90731-3603

Phone

(310) 833-2575

Fax

(310) 832-2531

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• F D M Exclusive Image Inc

  • Community/Retail Pharmacy
  • San Pedro, CA
  • NPI 1992710545
  NPD (past) Authorized official

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470614400000",
    "number": "1487793741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "891 W 9TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313603",
            "telephone_number": "310-833-2575",
            "fax_number": "310-832-2531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 W 9TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313603",
            "telephone_number": "310-833-2575",
            "fax_number": "310-832-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSOUDI",
        "first_name": "FARIBORZ",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2016-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY45471",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "PHY45471",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luz E Martinez
• Melissa Renee Martinez, M.A.
• Siamak Stephen Marzban, M.D.
• Louis Mascola, DDS
• Cheri Masek, CLC
• Giti Massoudian, DDS.
• Liliana Mastroianni
• Damien Mata
• Julia Mathews, PT, NCS
• Brianna Aiko Matsuura

• Pharmacy in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; 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.