Provider Demographics
NPI:1134553993
Name:FARRIOR, ALICE (BS, CLS)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:FARRIOR
Suffix:
Gender:F
Credentials:BS, CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 ROSEMOUNT LN
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5719
Mailing Address - Country:US
Mailing Address - Phone:510-755-6838
Mailing Address - Fax:
Practice Address - Street 1:2238 ROSEMOUNT LN
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5719
Practice Address - Country:US
Practice Address - Phone:510-755-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA00036182246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist