Healthcare Provider Details

I. General information

NPI: 1457455602
Provider Name (Legal Business Name): RANDALL A FARAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 UPPER RAGSDALE DR
MONTEREY CA
93940
US

IV. Provider business mailing address

12 UPPER RAGSDALE DR
MONTEREY CA
93940-5730
US

V. Phone/Fax

Practice location:
  • Phone: 831-648-7200
  • Fax: 831-648-7204
Mailing address:
  • Phone: 831-648-7200
  • Fax: 831-648-7204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA97053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: