Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 43157 | CA |
NPI | 1003239013 |
---|---|
Provider Name | Dr. Allen Fari |
First Address | Corona, CA 92882-4362 |
Second Address | Corona, CA 92882-4362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2014 |
Last Update Date | 27/01/2014 |