Provider Demographics
NPI:1134457799
Name:VIOLETTA FARYNO MD INC
Entity Type:Organization
Organization Name:VIOLETTA FARYNO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIOLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARYNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-288-9933
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94023-0070
Mailing Address - Country:US
Mailing Address - Phone:408-288-9933
Mailing Address - Fax:408-286-7730
Practice Address - Street 1:2577 SAMARITAN DR STE 720
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4100
Practice Address - Country:US
Practice Address - Phone:408-288-9933
Practice Address - Fax:408-286-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A503430Medicare PIN
CAG01568Medicare UPIN