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General NPI Number Information
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NPI Number | 1891461042
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Entity Type | Individual
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Provider Name | POONEH NICHOL FARAH NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 11034 W MILITARY DR STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78251-1938
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Country | US
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Telephone | 281-783-8162
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Fax |
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Provider Business Mailing Address
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Address Line | 5807 CECILYANN
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6410
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Country | US
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Telephone | 210-325-5849
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1047555
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 1047555
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1047555
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License Number State | TX
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