MEDICARE: PATRICIA FERJANI

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	174400000X	Specialist	21791	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21791	OTHER	CA	225700000X

General Provider Information

NPI Number	:	1366781643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA FERJANI

Provider Business Mailing Address
First Line	:	4395 MENTONE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-1119
Country	:	US
Telephone Number	:	619-592-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 GARNET AVE
Second Line	:	SUITE 1I
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3610
Country	:	US
Telephone Number	:	619-592-3049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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Directions to “ PATRICIA FERJANI ” Practice Location

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