Healthcare Provider Details

I. General information

NPI: 1811906175
Provider Name (Legal Business Name): DARREN ALAN FARNESI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 AUSTIN DR SUITE 203
SPRING VALLEY CA
91978-1522
US

IV. Provider business mailing address

10225 AUSTIN DR SUITE 203
SPRING VALLEY CA
91978-1522
US

V. Phone/Fax

Practice location:
  • Phone: 619-660-9068
  • Fax: 619-660-7640
Mailing address:
  • Phone: 619-660-9068
  • Fax: 619-660-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA 72585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: