Basic Information
Provider Information
NPI: 1003016635
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FARRAH
FirstName: LILLIAN
MiddleName: P
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4770 YORK BLVD APT 112
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900421678
CountryCode: US
TelephoneNumber: 2136751500
FaxNumber:  
Practice Location
Address1: 550 S VERMONT AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900201912
CountryCode: US
TelephoneNumber: 2137382318
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/22/2007
LastUpdateDate: 07/22/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X CAY Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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