MEDICARE: CHARLES FARIS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	F0910011501	CA

General Provider Information

NPI Number	:	1871968925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES FARIS

Provider Business Mailing Address
First Line	:	1652 E DEL MAR BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2706
Country	:	US
Telephone Number	:	626-792-5508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1652 E DEL MAR BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2706
Country	:	US
Telephone Number	:	626-792-5508
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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Directions to “ CHARLES FARIS ” Practice Location

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