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General NPI Number Information
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NPI Number | 1174343800
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Entity Type | Organization
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Legal Business Name | FARAJA HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 5000 RIVERSIDE DR BLDG 6
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City | IRVING
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State | TX
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Zip | 75039-4316
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Country | US
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Telephone | 214-554-1945
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Fax |
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Provider Business Mailing Address
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Address Line | 5923 SILVER SAGE LN
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-8748
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. PAUL MAYOMBOLA
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Credential | DNP, AGACNP-BC
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Telephone | 214-554-1945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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