Provider Demographics
NPI:1891201067
Name:FARIDA, RANA THERESA
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:THERESA
Last Name:FARIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 HIDDEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-5800
Mailing Address - Country:US
Mailing Address - Phone:619-997-0052
Mailing Address - Fax:
Practice Address - Street 1:2144 HIDDEN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-5800
Practice Address - Country:US
Practice Address - Phone:619-997-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-23
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician