1093015992 NPI number — LAUREN NASH FARAC MD

Table of content: LAUREN NASH FARAC MD (NPI 1093015992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093015992 NPI number — LAUREN NASH FARAC MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARAC
Provider First Name:
LAUREN
Provider Middle Name:
NASH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIZZELL
Provider Other First Name:
LAUREN
Provider Other Middle Name:
NASH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093015992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WILSON RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-7885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-242-8301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23625 HOLMAN HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-624-5311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2010

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: 207L00000X , with the licence number:  A129635 , 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)