Healthcare Provider Details

I. General information

NPI: 1174007165
Provider Name (Legal Business Name): CAROLINE FEDERIGHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 EL CAPITAN DR STE 200
DANVILLE CA
94526-6260
US

IV. Provider business mailing address

1320 EL CAPITAN DR STE 200
DANVILLE CA
94526-6260
US

V. Phone/Fax

Practice location:
  • Phone: 925-275-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: