MEDICARE: JOE PASILLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	171M00000X	Case Manager/Care Coordinator	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900406	OTHER	CA	STAFF ID NUMBER
2	100213	OTHER	CA	STAFF NUMBER

General Provider Information

NPI Number	:	1730222936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE PASILLAS

Provider Business Mailing Address
First Line	:	258 N BLACKSTONE AVE
Second Line	:	SUITE # 102
City	:	FRESNO
State	:	CA
Zip	:	93701-1913
Country	:	US
Telephone Number	:	559-274-0299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 N WEST AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-2759
Country	:	US
Telephone Number	:	559-274-0299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/17/2020

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Directions to “ JOE PASILLAS ” Practice Location

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