Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 0438327 | KS |
N | 207K00000X | Allergist & Immunologist | ME46902 | FL |
Y | 2080P0201X | Pediatric Allergist | G162574 | CA |
NPI | 1104845775 |
---|---|
Provider Name | Dr. John P. Faraci |
First Address | Loma Linda, CA 92354-3450 |
Second Address | Loma Linda, CA 92354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D37255 | (02) | FL |