Healthcare Provider Details

I. General information

NPI: 1932983079
Provider Name (Legal Business Name): MARISOL FARFAN OSEGUERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 ADAMS ST STE A410
RIVERSIDE CA
92504-8306
US

IV. Provider business mailing address

2900 ADAMS ST STE A410
RIVERSIDE CA
92504-8306
US

V. Phone/Fax

Practice location:
  • Phone: 951-403-4156
  • Fax:
Mailing address:
  • Phone: 951-403-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW131978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: