Provider Demographics
NPI:1679331870
Name:FARRAR-MULLIS, CATTAREYA JO
Entity type:Individual
Prefix:MRS
First Name:CATTAREYA
Middle Name:JO
Last Name:FARRAR-MULLIS
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 1:201 RIVER POINTE DR APT 121
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2894
Mailing Address - Country:US
Mailing Address - Phone:832-794-0079
Mailing Address - Fax:
Practice Address - Street 1:201 RIVER POINTE DR APT 121
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2894
Practice Address - Country:US
Practice Address - Phone:832-794-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program