Healthcare Provider Details

I. General information

NPI: 1447655055
Provider Name (Legal Business Name): ADAM FARBER C.R.N.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V STREET, UCDMC DEPT OF ANESTHESIOLOGY AND PAIN PSSB STE 1200
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V STREET, UCDMC DEPT OF ANESTHESIOLOGY AND PAIN PSSB STE 1200
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5028
  • Fax: 916-734-2975
Mailing address:
  • Phone: 916-734-5028
  • Fax: 916-734-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: