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NPI Code Detail

MEDICARE: GINGER ANN FARIAS BS

MEDICARE: GINGER ANN FARIAS BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian00961055CA

General Provider Information

NPI Number : 1073700191
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINGER ANN FARIAS BS
Provider Business Mailing Address
First Line : 1339 WEST GAVEY AVENUE NORTH
Second Line :
City : WEST COVINA
State : CA
Zip : 91790-2242
Country : US
Telephone Number : 626-814-0111
Fax Number : 626-389-5426
Provider Business Practice Location Address
First Line : 1339 WEST GAVEY AVENUE NORTH
Second Line :
City : WEST COVINA
State : CA
Zip : 91790-2242
Country : US
Telephone Number : 626-814-0111
Fax Number : 626-389-5426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2007
Last Update Date : 03/13/2013

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