Healthcare Provider Details

I. General information

NPI: 1467323501
Provider Name (Legal Business Name): BAHAREH FARRAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAHARE FARRAHI

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 W FALLBROOK AVE STE 106
FRESNO CA
93711-6225
US

IV. Provider business mailing address

1187 N WILLOW AVE STE 103 PMB 483
CLOVIS CA
93611-4411
US

V. Phone/Fax

Practice location:
  • Phone: 559-795-5990
  • Fax:
Mailing address:
  • Phone: 559-347-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW139589
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: