MEDICARE: RANA THERESA FARIDA

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1891201067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANA THERESA FARIDA

Provider Business Mailing Address
First Line	:	2144 HIDDEN SPRINGS DR
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-5800
Country	:	US
Telephone Number	:	619-997-0052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2144 HIDDEN SPRINGS DR
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-5800
Country	:	US
Telephone Number	:	619-997-0052
Fax Number	:

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

Provider Enumeration Date	:	12/23/2017
Last Update Date	:	12/23/2017

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Directions to “ RANA THERESA FARIDA ” Practice Location

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