Healthcare Provider Details

I. General information

NPI: 1245146125
Provider Name (Legal Business Name): ALEYDIS IRENE FARRERA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COFFEE RD
MODESTO CA
95355-4233
US

IV. Provider business mailing address

PO BOX 211
TURLOCK CA
95381-0211
US

V. Phone/Fax

Practice location:
  • Phone: 209-554-6808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: