Provider Demographics
NPI:1639823461
Name:FARRAJ, RAED
Entity Type:Individual
Prefix:
First Name:RAED
Middle Name:
Last Name:FARRAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18498 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5319
Mailing Address - Country:US
Mailing Address - Phone:954-732-6326
Mailing Address - Fax:
Practice Address - Street 1:18498 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-5319
Practice Address - Country:US
Practice Address - Phone:954-732-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory