Healthcare Provider Details

I. General information

NPI: 1902401698
Provider Name (Legal Business Name): JOANNE LEE FLEMING LOYARTE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S IMPERIAL HWY
ANAHEIM CA
92807-3943
US

IV. Provider business mailing address

PO BOX 853
BREA CA
92822-0853
US

V. Phone/Fax

Practice location:
  • Phone: 562-879-7996
  • Fax:
Mailing address:
  • Phone: 562-879-7996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: