1043679095 NPI number — REJUVE-NATIONS OUTPATIENTS FACILITY, INC.

Table of content: SYED AHMED FARHAN MD (NPI 1952296204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043679095 NPI number — REJUVE-NATIONS OUTPATIENTS FACILITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REJUVE-NATIONS OUTPATIENTS FACILITY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1043679095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 152841
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92195-2841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-602-9405
Provider Business Mailing Address Fax Number:
951-657-7180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STUITE E204, E205
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-602-9405
Provider Business Practice Location Address Fax Number:
951-657-7180
Provider Enumeration Date:
02/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SQUARREL
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LEONOR
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
619-602-9405

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  370105AN , 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)





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