Healthcare Provider Details

I. General information

NPI: 1124548276
Provider Name (Legal Business Name): MS. CONNIE ANNE HSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18700 BEACH BLVD STE 160
HUNTINGTON BEACH CA
92648-2073
US

IV. Provider business mailing address

6121 CAPRI CT
LONG BEACH CA
90803-4858
US

V. Phone/Fax

Practice location:
  • Phone: 714-654-1570
  • Fax:
Mailing address:
  • Phone: 310-923-6767
  • 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: