Basic Information
| Provider Information | |||||||||
| NPI: | 1962131391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURAN FARFAN | ||||||||
| FirstName: | GISELLE | ||||||||
| MiddleName: | ANGELICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2585 TENNYSON CT | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913601627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056576047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5740 RALSTON ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052893100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2022 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.