Healthcare Provider Details

I. General information

NPI: 1063393007
Provider Name (Legal Business Name): JESIKA FARHADI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 LOCUST ST
MODESTO CA
95351-2699
US

IV. Provider business mailing address

426 LOCUST ST
MODESTO CA
95351-2699
US

V. Phone/Fax

Practice location:
  • Phone: 209-492-3443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: