Healthcare Provider Details

I. General information

NPI: 1356217368
Provider Name (Legal Business Name): CHIDALE OHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

928 MARIN ST # B
VALLEJO CA
94590-5432
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8338
  • Fax: 707-427-2774
Mailing address:
  • Phone: 707-704-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: