Healthcare Provider Details

I. General information

NPI: 1154984078
Provider Name (Legal Business Name): MARGARITA JOSEPHINE VASQUEZ MA, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARGARITA JOSEPHINE ESTRADA MA, AMFT

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S HARBOR BLVD
ANAHEIM CA
92805-3700
US

IV. Provider business mailing address

222 S HARBOR BLVD
ANAHEIM CA
92805-3700
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-5646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: