Provider Demographics
NPI:1740592120
Name:SURTI, FARHAT S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:FARHAT
Middle Name:S
Last Name:SURTI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4520 BUSINESS DRIVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6888
Mailing Address - Country:US
Mailing Address - Phone:707-646-3555
Mailing Address - Fax:707-646-3556
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:SUITE NUMBER 31
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:510-232-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily