1861674004 NPI number — MILYNNE IBARRA FARRALES M.A., LMFT

Table of content: MILYNNE IBARRA FARRALES M.A., LMFT (NPI 1861674004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861674004 NPI number — MILYNNE IBARRA FARRALES M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRALES
Provider First Name:
MILYNNE
Provider Middle Name:
IBARRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IBARRA
Provider Other First Name:
MILYNNE
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861674004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 TREEWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95132-1244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-464-5370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 PARKMOOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-282-0402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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