Provider Demographics
NPI:1710106737
Name:RAOUFI, FARZANEH (FNP)
Entity Type:Individual
Prefix:MS
First Name:FARZANEH
Middle Name:
Last Name:RAOUFI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4593
Mailing Address - Country:US
Mailing Address - Phone:650-578-0400
Mailing Address - Fax:
Practice Address - Street 1:19 WEST 39TH STREET
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4549
Practice Address - Country:US
Practice Address - Phone:650-578-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13945363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care