Healthcare Provider Details

I. General information

NPI: 1841732005
Provider Name (Legal Business Name): MISS NATALIE SARAI ELISARRARAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 N RAYMOND AVE STE 200
ANAHEIM CA
92801
US

IV. Provider business mailing address

27261 LAS RAMBLAS STE 200
MISSION VIEJO CA
92691-6472
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-8650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: