Ian R. Farrell, PA-C
Individual provider Active NPI Physician Assistant · King City, CA
NPI 1497731053 · NPPES record last updated Aug 6, 2015
Key facts
- NPI
- 1497731053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA16288 (CA)
- Practice address
- 210 Canal St
King City, CA 93930-3432 - Phone
- (831) 385-5471
- Fax
- (831) 385-5940
- NPI assigned
- Dec 15, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA16288 | CA | MD | Physician Assistant |
| 16288 | CA | MD | Pediatric Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA16288 | CA | Yes |
Addresses
Primary practice location
210 Canal St
King City, CA 93930-3432
Mailing address
210 Canal St
King City, CA 93930-3432
Phone (831) 385-5471
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA162880 | Medicaid | CA |
Other providers in King City, CA
- Vijay Diesh
- Door to Hope
- Ariam Marlene Espinosa
- Jessica Espinosa
- Richard H. Fair
- Beatriz Fernandez
- Julio Flores Ramirez
- Gilbert E. Flores
- Tammy Lynn Fuller
- Gallardo Network LLC
All providers in King City, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.