Healthcare Provider Details

I. General information

NPI: 1427759810
Provider Name (Legal Business Name): JONATHAN EDWARD ARTIGUE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W PEARL ST
ANAHEIM CA
92801-5940
US

IV. Provider business mailing address

16638 VAN NESS AVE
TORRANCE CA
90504-2200
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-1174
  • Fax:
Mailing address:
  • Phone: 310-200-9352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: