Provider Demographics
NPI:1891821427
Name:EITAN HOMA AND JENNIFER KRASNOFF MD INC
Entity Type:Organization
Organization Name:EITAN HOMA AND JENNIFER KRASNOFF MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-762-5976
Mailing Address - Street 1:165 LYNCH CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2343
Mailing Address - Country:US
Mailing Address - Phone:707-762-5976
Mailing Address - Fax:
Practice Address - Street 1:165 LYNCH CREEK WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2343
Practice Address - Country:US
Practice Address - Phone:707-762-5976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01660ZMedicare ID - Type Unspecified