Provider Demographics
NPI:1285650911
Name:FARYNO, VIOLETTA (MD)
Entity Type:Individual
Prefix:
First Name:VIOLETTA
Middle Name:
Last Name:FARYNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01568Medicare UPIN
CA00A503430Medicare ID - Type Unspecified