Healthcare Provider Details

I. General information

NPI: 1588649602
Provider Name (Legal Business Name): SUSAN FARRISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 13TH ST
RAMONA CA
92065-2711
US

IV. Provider business mailing address

15611 POMERADO RD STE 400
POWAY CA
92064-2437
US

V. Phone/Fax

Practice location:
  • Phone: 760-789-5160
  • Fax:
Mailing address:
  • Phone: 760-291-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC157397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: