Healthcare Provider Details

I. General information

NPI: 1780161760
Provider Name (Legal Business Name): AZADEH FARIBA ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15411 40TH DR SE
BOTHELL WA
98012
US

IV. Provider business mailing address

3670 STONE WAY N
SEATTLE WA
98103-8004
US

V. Phone/Fax

Practice location:
  • Phone: 858-722-7037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: