Healthcare Provider Details

I. General information

NPI: 1215170147
Provider Name (Legal Business Name): LAUREN FARASH M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 12/16/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SAMARITAN DR SUITE 607
SAN JOSE CA
95124-4006
US

IV. Provider business mailing address

4155 CESAR CHAVEZ ST #4
SAN FRANCISCO CA
94131-1957
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA104587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: