Provider Demographics
NPI:1154147502
Name:FA, LO-ER
Entity type:Individual
Prefix:
First Name:LO-ER
Middle Name:
Last Name:FA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EDMONDS RD
Mailing Address - Street 2:BUILDING D
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062
Mailing Address - Country:US
Mailing Address - Phone:650-209-1100
Mailing Address - Fax:
Practice Address - Street 1:240 EDMONDS RD
Practice Address - Street 2:BUILDING D
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-209-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735444164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse