Healthcare Provider Details

I. General information

NPI: 1083105613
Provider Name (Legal Business Name): JONATHAN PALARCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 BUSKIRK AVE STE 210
PLEASANT HILL CA
94523-4304
US

IV. Provider business mailing address

2420 MARTIN RD STE 200
FAIRFIELD CA
94534-8610
US

V. Phone/Fax

Practice location:
  • Phone: 925-933-2627
  • Fax:
Mailing address:
  • Phone: 707-399-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: