MEDICARE: JACOB FATURECHI

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	104100000X	Social Worker
2	101Y00000X	Counselor
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker	139391	CA
5	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1922880319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB FATURECHI

Provider Business Mailing Address
First Line	:	14500 ROSCOE BLVD FL 4
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4194
Country	:	US
Telephone Number	:	310-849-8024
Fax Number	:

Provider Business Practice Location Address
First Line	:	14500 ROSCOE BLVD FL 4
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4194
Country	:	US
Telephone Number	:	310-849-8024
Fax Number	:

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

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	06/23/2026

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Directions to “ JACOB FATURECHI ” Practice Location

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