Healthcare Provider Details

I. General information

NPI: 1376453712
Provider Name (Legal Business Name): JENIN FARAJALLAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S MILLS RD STE 200
VENTURA CA
93003-3453
US

IV. Provider business mailing address

6403 57TH AVE NE
SEATTLE WA
98115-7812
US

V. Phone/Fax

Practice location:
  • Phone: 805-250-7505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT310858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: