Healthcare Provider Details

I. General information

NPI: 1437434131
Provider Name (Legal Business Name): MICHAEL FARRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 OAK GROVE RD SUITE 12
CONCORD CA
94518-3289
US

IV. Provider business mailing address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

V. Phone/Fax

Practice location:
  • Phone: 925-229-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: