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1932913746 NPI number — FARDOSA ABDULLAH FARAH

NPI Number: 1932913746
Health Care Provider/Practitioner: FARDOSA ABDULLAH FARAH

Information about “1932913746” NPI (FARDOSA ABDULLAH FARAH) exists in 1932913746 in HTML format HTML  |  1932913746 in plain Text format TXT  |  1932913746 in PDF (Portable Document Format) PDF  |  1932913746 in an XML format XML  formats.

NPI Number : 1932913746 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1932913746",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FARAH",
    "FirstName": "FARDOSA",
    "MiddleName": "ABDULLAH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6265 MONTICELLO LN N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAPLE GROVE",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55369-6285",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "612-707-0477",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10650 RED CIRCLE DR STE 320",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MINNETONKA",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55343-9117",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "612-987-3455",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/03/2025",
    "LastUpdateDate": "02/03/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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