Healthcare Provider Details

I. General information

NPI: 1225387301
Provider Name (Legal Business Name): KAREN PAULINE FARAC DPM, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COLLEGE AVE.
SANTA ROSA CA
95404
US

IV. Provider business mailing address

979 GOLF COURSE DR. #176
ROHNERT PARK CA
94928
US

V. Phone/Fax

Practice location:
  • Phone: 707-332-2882
  • Fax:
Mailing address:
  • Phone: 707-332-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: