Provider Demographics
NPI:1669675781
Name:DESILVA, FALAYA
Entity Type:Individual
Prefix:
First Name:FALAYA
Middle Name:
Last Name:DESILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 S MAIN ST
Mailing Address - Street 2:201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5303
Mailing Address - Country:US
Mailing Address - Phone:951-279-1333
Mailing Address - Fax:951-279-8333
Practice Address - Street 1:2275 S MAIN ST
Practice Address - Street 2:201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5303
Practice Address - Country:US
Practice Address - Phone:951-279-1333
Practice Address - Fax:951-279-8333
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA69941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist