MEDICARE: MS. FARZANEH RAOUFI FNP

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	363LP2300X	Primary Care Nurse Practitioner	NP13945	CA

General Provider Information

NPI Number	:	1710106737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FARZANEH RAOUFI FNP

Provider Business Mailing Address
First Line	:	19 W 39TH AVE
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-4593
Country	:	US
Telephone Number	:	650-578-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 WEST 39TH STREET
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-4549
Country	:	US
Telephone Number	:	650-578-0400
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/21/2014

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