Active NPI
Mitra Fazel
- Pharmacist
- Fair Oaks, CA
National Provider Identifier
1740756915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 79695
- Practice address
- 4842 Sunset Ter Apt D
Fair Oaks, CA 95628-5066 - Phone
- (510) 366-9576
- NPI assigned
- Oct 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 79695 | CA | Primary |
Addresses
Primary practice location
4842 Sunset Ter Apt D
Fair Oaks, CA 95628-5066
Mailing address
4842 Sunset Ter Apt D
Fair Oaks, CA 95628-5066
Phone (510) 366-9576
Other practice location 1
4842 Sunset Ter Apt D
Fair Oaks, CA 95628-5066
Phone (510) 366-9576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79695 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539648000000",
"number": "1740756915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4842 SUNSET TER APT D",
"city": "FAIR OAKS",
"state": "CA",
"postal_code": "956285066",
"telephone_number": "510-366-9576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4842 SUNSET TER APT D",
"city": "FAIR OAKS",
"state": "CA",
"postal_code": "956285066",
"telephone_number": "510-366-9576"
}
],
"practiceLocations": [
{
"address_1": "4842 Sunset Ter Apt D",
"address_purpose": "LOCATION",
"city": "Fair Oaks",
"state": "CA",
"postal_code": "956285066",
"country_code": "US",
"telephone_number": "510-366-9576",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FAZEL",
"first_name": "MITRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-16",
"last_updated": "2018-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "79695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fair Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.