Healthcare Provider Details

I. General information

NPI: 1669381570
Provider Name (Legal Business Name): MISS TRISHA MARIE GOPEZ AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41111 MISSION BLVD STE 101
FREMONT CA
94539-3922
US

IV. Provider business mailing address

5312 TACOMA CMN
FREMONT CA
94555-2757
US

V. Phone/Fax

Practice location:
  • Phone: 833-878-7864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT160208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: