Healthcare Provider Details

I. General information

NPI: 1508055310
Provider Name (Legal Business Name): MAURICE ANDRE HERBELIN-FARRAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

PO BOX 191643
SACRAMENTO CA
95819-7643
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-1362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberA79684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: