Healthcare Provider Details

I. General information

NPI: 1124842117
Provider Name (Legal Business Name): NEDA FARROKHNIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 ALMOND CT
SAN RAFAEL CA
94903-5004
US

IV. Provider business mailing address

83 ALMOND CT
SAN RAFAEL CA
94903-5004
US

V. Phone/Fax

Practice location:
  • Phone: 415-497-8286
  • Fax:
Mailing address:
  • Phone: 415-497-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: