Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 26362 | AL |
Y | 207X00000X | Orthopaedic Surgeon | A104802 | CA |
NPI | 1023227733 |
---|---|
Provider Name | Charissa Farris |
First Address | San Jose, CA 95124-4108 |
Second Address | San Jose, CA 95124-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 03/10/2013 |