Healthcare Provider Details

I. General information

NPI: 1245369214
Provider Name (Legal Business Name): DEBORAH A FARYNIARZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 SAMARITAN DRIVE
SAN JOSE CA
95124-3907
US

IV. Provider business mailing address

2430 SAMARITAN DRIVE
SAN JOSE CA
95124-3907
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-3888
  • Fax: 408-371-6387
Mailing address:
  • Phone: 408-559-3888
  • Fax: 408-371-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH ANN FARYNIARZ
Title or Position: CEO, SECRETARY
Credential: MD
Phone: 408-559-3888