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General NPI Number Information
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NPI Number | 1720114432
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Entity Type | Individual
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Provider Name | SHALA RAHBAR FARDIN MD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 2330 MARINSHIP WAY STE 370
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City | SAUSALITO
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State | CA
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Zip | 94965-2853
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Country | US
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Telephone | 415-887-9758
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Fax | 415-887-9763
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Provider Business Mailing Address
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Address Line | 2330 MARINSHIP WAY STE 370
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City | SAUSALITO
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State | CA
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Zip | 94965-2853
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Country | US
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Telephone | 415-887-9758
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Fax | 415-887-9763
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | P-230971
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A98841
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License Number State | CA
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