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General NPI Number Information
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NPI Number | 1255962338
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Entity Type | Individual
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Provider Name | PHOEBE IRABAGON PANTALEON-FATHALLAH
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 2101 E 1ST ST
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City | SANTA ANA
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State | CA
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Zip | 92705-4007
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Country | US
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Telephone | 714-542-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1381670320
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 141555
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT126592
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717002572
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | TPMF1927
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License Number State | FL
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