Healthcare Provider Details

I. General information

NPI: 1295923613
Provider Name (Legal Business Name): DESIRAE HUTCHINSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 CEDAR RIDGE LN
CORONA CA
92881-8706
US

IV. Provider business mailing address

1259 EL CAMINO REAL UNIT 1101
MENLO PARK CA
94025-4208
US

V. Phone/Fax

Practice location:
  • Phone: 951-515-2838
  • Fax:
Mailing address:
  • Phone: 951-515-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: