Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A23806 | CA |
NPI | 1013960848 |
---|---|
Provider Name | Dr. Donald Omar Fareed |
First Address | Santa Barbara, CA 93150-0547 |
Second Address | Santa Barbara, CA 93108-1249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A23697 | (02) | CA |