MEDICARE: JENNIFER FARIA

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
1	224L00000X	Pedorthist

General Provider Information

NPI Number	:	1295378891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER FARIA

Provider Business Mailing Address
First Line	:	438 ANNETTE AVE
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-6574
Country	:	US
Telephone Number	:	510-672-6694
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 GEORGIA ST STE 322
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94590-5945
Country	:	US
Telephone Number	:	510-672-6694
Fax Number	:

Authorized Official
Title or Position	:	PEDORTHIST
Name	:	JENNIFER FARIA
Credential	:
Telephone Number	:	510-672-6694

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	10/26/2019

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