Active NPI
Khadijah Al-Faraj, BCBA
- Behavior Analyst
- Stockton, CA
National Provider Identifier
1285075440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-13-13495
- Practice address
- 3244 Brookside Rd Ste 140
Stockton, CA 95219-2359 - Phone
- (209) 521-4791
- Fax
- (209) 521-4794
- NPI assigned
- Jul 16, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-13-13495 | CA | Primary |
Addresses
Primary practice location
3244 Brookside Rd Ste 140
Stockton, CA 95219-2359
Mailing address
3244 Brookside Rd Ste 140
Stockton, CA 95219-2359
Phone (209) 521-4791
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373932800000",
"number": "1285075440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3244 BROOKSIDE RD STE 140",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952192359",
"telephone_number": "209-521-4791",
"fax_number": "209-521-4794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3244 BROOKSIDE RD STE 140",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952192359",
"telephone_number": "209-521-4791",
"fax_number": "209-521-4794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AL-FARAJ",
"first_name": "KHADIJAH",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-16",
"last_updated": "2013-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-13-13495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.