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NPI Code Detail

MEDICARE: BRUCE FARWELL

MEDICARE: BRUCE FARWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY13583CA

General Provider Information

NPI Number : 1962547380
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE FARWELL
Provider Business Mailing Address
First Line : 9650 ZELZAH AVE
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91325-2003
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9650 ZELZAH AVE
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91325-2003
Country : US
Telephone Number : 818-739-5142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 07/08/2007

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Directions to “ BRUCE FARWELL ” Practice Location

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