Provider Demographics
NPI:1629475538
Name:FARVON, SHIVA
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:FARVON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIVA
Other - Middle Name:
Other - Last Name:GHAFARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FP
Mailing Address - Street 1:2613 PIPER COURT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306
Mailing Address - Country:US
Mailing Address - Phone:661-332-1316
Mailing Address - Fax:
Practice Address - Street 1:1700 MT. VERNON
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306
Practice Address - Country:US
Practice Address - Phone:661-326-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily