Healthcare Provider Details

I. General information

NPI: 1336379437
Provider Name (Legal Business Name): CLARISSA TEGAN FAUTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF ANATOMIC PATHOLOGY, CHILDREN'S AND WOMEN' HEALTH CENTRE, 4480 OAK STREET, ROOM L220
VANCOUVER BC
V6H 3V4
CA

IV. Provider business mailing address

DEPARTMENT OF ANATOMIC PATHOLOGY, CHILDREN'S AND WOMEN' HEALTH CENTRE, 4480 OAK STREET, ROOM L220
VANCOUVER BC
V6H 3V4
CA

V. Phone/Fax

Practice location:
  • Phone: 604-875-2395
  • Fax: 604-875-3529
Mailing address:
  • Phone: 604-875-2395
  • Fax: 604-875-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number32119
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: