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1255962338 NPI number — PHOEBE IRABAGON PANTALEON-FATHALLAH

NPI Number: 1255962338
Health Care Provider/Practitioner: PHOEBE IRABAGON PANTALEON-FATHALLAH

Information about “1255962338” NPI (PHOEBE IRABAGON PANTALEON-FATHALLAH) exists in 1255962338 in HTML format HTML  |  1255962338 in plain Text format TXT  |  1255962338 in PDF (Portable Document Format) PDF  |  1255962338 in an XML format XML  formats.

NPI Number : 1255962338 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255962338",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PANTALEON-FATHALLAH",
    "FirstName": "PHOEBE",
    "MiddleName": "IRABAGON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PANTALEON",
    "OtherFirstName": "PHOEBE",
    "OtherMiddleName": "IRABAGON",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5201 GREAT AMERICA PKWY STE 320",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANTA CLARA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95054-1140",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2101 E 1ST ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SANTA ANA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92705-4007",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-542-3581",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/28/2020",
    "LastUpdateDate": "01/23/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "R1381670320",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "141555",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "AMFT126592",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "0717002572",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106H00000X",
          "TaxonomyName": "Marriage & Family Therapist",
          "LicenseNumber": "TPMF1927",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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