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General NPI Number Information
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NPI Number | 1295378891
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Entity Type | Organization
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Legal Business Name | JENNIFER FARIA
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Dates
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Enumeration Date | 10/26/2019
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Last Update Date | 10/26/2019
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Provider Practice Location Address
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Address Line | 301 GEORGIA ST STE 322
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City | VALLEJO
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State | CA
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Zip | 94590-5945
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Country | US
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Telephone | 510-672-6694
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Fax |
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Provider Business Mailing Address
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Address Line | 438 ANNETTE AVE
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City | VALLEJO
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State | CA
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Zip | 94591-6574
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Country | US
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Telephone | 510-672-6694
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Fax |
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Authorized Official
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Title or Position | PEDORTHIST
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Name | JENNIFER FARIA
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Credential |
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Telephone | 510-672-6694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number |
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License Number State |
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