Provider Demographics
NPI:1407563042
Name:FAURRIETA, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:FAURRIETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:FAURRIETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5454
Mailing Address - Country:US
Mailing Address - Phone:707-892-3263
Mailing Address - Fax:
Practice Address - Street 1:609 PALOMINO DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5454
Practice Address - Country:US
Practice Address - Phone:707-892-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health