Healthcare Provider Details

I. General information

NPI: 1174308498
Provider Name (Legal Business Name): VIENNA MARIE FARLOW HRHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 SHELTER ISLAND DR STE 105-609
SAN DIEGO CA
92106-2743
US

IV. Provider business mailing address

2907 SHELTER ISLAND DR STE 105-609
SAN DIEGO CA
92106-2743
US

V. Phone/Fax

Practice location:
  • Phone: 315-283-3283
  • Fax:
Mailing address:
  • Phone: 315-283-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: