Provider Demographics
NPI:1194057190
Name:ALFARO, JOSE OMAR (MFT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:OMAR
Last Name:ALFARO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 W AVENUE K STE 203C
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5925
Mailing Address - Country:US
Mailing Address - Phone:661-214-3044
Mailing Address - Fax:661-579-9310
Practice Address - Street 1:1805 W AVENUE K STE 203C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-214-3044
Practice Address - Fax:661-579-9310
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist