Healthcare Provider Details

I. General information

NPI: 1912192469
Provider Name (Legal Business Name): ARTHUR J. FARKAS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6046 CORNERSTONE CT W STE 113
SAN DIEGO CA
92121-4758
US

IV. Provider business mailing address

6046 CORNERSTONE CT W STE 113
SAN DIEGO CA
92121-4758
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-4315
  • Fax: 858-453-5690
Mailing address:
  • Phone: 858-453-4315
  • Fax: 858-453-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19905
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY19905
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY19905
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: