Healthcare Provider Details

I. General information

NPI: 1699442210
Provider Name (Legal Business Name): STEPHANIE JANETTE PEREZ LORENZANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1597 BAKER ST
COSTA MESA CA
92626-3746
US

IV. Provider business mailing address

1597 BAKER ST
COSTA MESA CA
92626-3746
US

V. Phone/Fax

Practice location:
  • Phone: 714-435-7940
  • Fax:
Mailing address:
  • Phone: 714-435-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: