Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 1822 | AZ |
NPI | 1225634116 |
---|---|
Provider Name | Kim Marie Farkas |
First Address | Mesa, AZ 85209-7068 |
Second Address | Gilbert, AZ 85233-2566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2020 |
Last Update Date | 07/12/2020 |