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General NPI Number Information
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NPI Number | 1730130824
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Entity Type | Individual
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Provider Name | SHAMA PATHAN FAROOQUI CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 4650 SUNSET BLVD. DEPARTMENT OF ANESTHESIOLOGY
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-361-2262
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Fax |
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Provider Business Mailing Address
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Address Line | 6308 SEAWALK DR
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City | LOS ANGELES
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State | CA
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Zip | 90094-2270
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Country | US
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Telephone | 919-622-1623
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 171982
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License Number State | NC
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