Healthcare Provider Details

I. General information

NPI: 1437990017
Provider Name (Legal Business Name): KARLA VALERIA ENRIQUEZ TAPIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BRISTOL ST
COSTA MESA CA
92626-5996
US

IV. Provider business mailing address

2801 BRISTOL ST STE 100
COSTA MESA CA
92626-5996
US

V. Phone/Fax

Practice location:
  • Phone: 714-850-8408
  • Fax:
Mailing address:
  • Phone: 714-850-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: