Provider Demographics
NPI:1902961477
Name:LOUIE, FARIDEH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:FARIDEH
Middle Name:
Last Name:LOUIE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 PERIDOT PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2644
Mailing Address - Country:US
Mailing Address - Phone:408-272-4552
Mailing Address - Fax:
Practice Address - Street 1:611 S MILPITAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5473
Practice Address - Country:US
Practice Address - Phone:408-945-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543015163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN543015Medicaid