Healthcare Provider Details

I. General information

NPI: 1457932022
Provider Name (Legal Business Name): DARLENE SUSAN VALDEZ-OLGUIN PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BREA BLVD STE 210
FULLERTON CA
92835-4128
US

IV. Provider business mailing address

1370 BREA BLVD STE 210
FULLERTON CA
92835-4128
US

V. Phone/Fax

Practice location:
  • Phone: 714-732-1773
  • Fax: 909-367-2922
Mailing address:
  • Phone: 714-732-1773
  • Fax: 909-367-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMR22525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: