Healthcare Provider Details

I. General information

NPI: 1316862790
Provider Name (Legal Business Name): VIDA PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18430 BROOKHURST ST STE 201G
FOUNTAIN VALLEY CA
92708-6757
US

IV. Provider business mailing address

18430 BROOKHURST ST STE 201G
FOUNTAIN VALLEY CA
92708-6757
US

V. Phone/Fax

Practice location:
  • Phone: 949-591-9508
  • Fax: 949-861-9816
Mailing address:
  • Phone: 949-591-9508
  • Fax: 949-861-9816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAURA MARISOL ZAMORA MACIAS
Title or Position: OWNER
Credential: PSYD., LMFT
Phone: 949-664-3218