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General NPI Number Information
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NPI Number | 1184242307
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Entity Type | Individual
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Provider Name | CECILIA FAIRLEY MS
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Gender | Female
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 747 52ND ST
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City | OAKLAND
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State | CA
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Zip | 94609-1809
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Country | US
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Telephone | 510-428-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 240 DOLORES ST APT 212
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2254
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Country | US
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Telephone | 415-515-6311
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Fax | 510-450-5974
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | GC00412
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License Number State | CA
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