Provider Demographics
NPI:1376224550
Name:FARJAT, TANIA LIZBETH
Entity Type:Individual
Prefix:MISS
First Name:TANIA
Middle Name:LIZBETH
Last Name:FARJAT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TANIA
Other - Middle Name:L
Other - Last Name:FARJAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21 KORBEL CT
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3037
Mailing Address - Country:US
Mailing Address - Phone:415-272-5241
Mailing Address - Fax:
Practice Address - Street 1:21 KORBEL CT
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3037
Practice Address - Country:US
Practice Address - Phone:415-272-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program