Healthcare Provider Details

I. General information

NPI: 1699886275
Provider Name (Legal Business Name): ROBERT E FARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STOCKTON BLVD #106
SACRAMENTO CA
95816-7097
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD #100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-9002
  • Fax: 916-262-9012
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC35929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: