Healthcare Provider Details

I. General information

NPI: 1063915718
Provider Name (Legal Business Name): PILAR YVETTE FARFAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S SAN JOAQUIN ST
STOCKTON CA
95202-3206
US

IV. Provider business mailing address

3707 ZEALLY LN
STOCKTON CA
95206-6133
US

V. Phone/Fax

Practice location:
  • Phone: 209-953-5451
  • Fax:
Mailing address:
  • Phone: 209-670-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138219
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-43275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: