Provider Demographics
NPI:1316653710
Name:FARNUM, MARIA ESMERALDA (LMT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ESMERALDA
Last Name:FARNUM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10733 W TURNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5457
Mailing Address - Country:US
Mailing Address - Phone:480-259-0592
Mailing Address - Fax:
Practice Address - Street 1:10733 W TURNEY AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5457
Practice Address - Country:US
Practice Address - Phone:480-259-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist