Healthcare Provider Details

I. General information

NPI: 1386597326
Provider Name (Legal Business Name): MR. DANIEL ROBERT LIVINGSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANNY LIVINGSTON

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST STE C208
COSTA MESA CA
92626-5946
US

IV. Provider business mailing address

17595 HARVARD AVE STE C-939
IRVINE CA
92614-8516
US

V. Phone/Fax

Practice location:
  • Phone: 949-381-1510
  • Fax:
Mailing address:
  • Phone: 949-414-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: