Healthcare Provider Details

I. General information

NPI: 1952756785
Provider Name (Legal Business Name): VICTORIA YOUNG MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MAREBLU
ALISO VIEJO CA
92656-3014
US

IV. Provider business mailing address

5 MAREBLU STE 100
ALISO VIEJO CA
92656-3014
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-6900
  • Fax:
Mailing address:
  • Phone: 949-643-6900
  • Fax: 494-643-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 70003
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT102286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: