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NPI Code Detail

MEDICARE: SUSAN FARRISH MD

MEDICARE: SUSAN FARRISH MD
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
1207Q00000XFamily Medicine PhysicianC157397CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C157397OTHERCAMEDICAL BOARD OF CALIFORNIA

General Provider Information

NPI Number : 1588649602
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN FARRISH MD
Provider Business Mailing Address
First Line : 15611 POMERADO RD STE 400
Second Line :
City : POWAY
State : CA
Zip : 92064-2437
Country : US
Telephone Number : 760-291-6650
Fax Number :
Provider Business Practice Location Address
First Line : 211 13TH ST
Second Line :
City : RAMONA
State : CA
Zip : 92065-2711
Country : US
Telephone Number : 760-789-5160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 08/16/2023

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