Provider Demographics
NPI:1215496294
Name:BOMAN, FARZANA
Entity type:Individual
Prefix:
First Name:FARZANA
Middle Name:
Last Name:BOMAN
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 1:10225 AUSTIN DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1522
Mailing Address - Country:US
Mailing Address - Phone:442-999-0593
Mailing Address - Fax:
Practice Address - Street 1:10225 AUSTIN DR STE 204
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1522
Practice Address - Country:US
Practice Address - Phone:442-999-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant