1609160498 NPI number — DR. VERA FARHOUD RAAD DDS

Table of content: DR. VERA FARHOUD RAAD DDS (NPI 1609160498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609160498 NPI number — DR. VERA FARHOUD RAAD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAAD
Provider First Name:
VERA
Provider Middle Name:
FARHOUD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609160498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2611 WILLOWGLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUARTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91010-3622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-357-3091
Provider Business Mailing Address Fax Number:
626-335-7911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 W ROUTE 66
Provider Second Line Business Practice Location Address:
SUITE 316
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91740-6249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-335-7727
Provider Business Practice Location Address Fax Number:
626-335-7911
Provider Enumeration Date:
06/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  43652 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)