Provider Demographics
NPI:1730127630
Name:FARIS, JUDITH ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:FARIS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:795 WILLOW RD
Mailing Address - Street 2:BLDG 352-121
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2539
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-617-2624
Practice Address - Street 1:795 WILLOW RD
Practice Address - Street 2:BLDG 352-121
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA244835363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health