Healthcare Provider Details

I. General information

NPI: 1912126350
Provider Name (Legal Business Name): SHUKRI YOUSEF ADAM-FARAH RN, PHN, MHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3896 50TH ST
SAN DIEGO CA
92105
US

IV. Provider business mailing address

3851 ROSECRANS ST MS P511F
SAN DIEGO CA
92110-3115
US

V. Phone/Fax

Practice location:
  • Phone: 619-757-0441
  • Fax: 619-640-6833
Mailing address:
  • Phone: 619-692-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number584384
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number584384
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number584384
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number584384
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number584384
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number584384
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number584384
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number584384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: