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General NPI Number Information
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NPI Number | 1629644497
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Entity Type | Individual
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Provider Name | FARIDE HERRAN ATALA
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Gender | Female
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 3435 CAMINO DEL RIO S STE 219
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City | SAN DIEGO
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State | CA
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Zip | 92108-3911
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Country | US
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Telephone | 619-724-2216
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Fax |
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Provider Business Mailing Address
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Address Line | 1372 13TH ST APT 3
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-3715
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Country | US
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Telephone | 619-913-9408
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 123061
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License Number State | CA
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