Healthcare Provider Details

I. General information

NPI: 1588544365
Provider Name (Legal Business Name): FABIOLA FARFAN-MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 COLE AVE
LOS ANGELES CA
90038-2610
US

IV. Provider business mailing address

2932 GREENBRIAR DR
ONTARIO CA
91761-5034
US

V. Phone/Fax

Practice location:
  • Phone: 213-574-3793
  • Fax:
Mailing address:
  • Phone: 323-620-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: