Healthcare Provider Details

I. General information

NPI: 1942525076
Provider Name (Legal Business Name): AIDA VAZIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 02/22/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 CAMELBACK ST UNIT 9763
NEWPORT BEACH CA
92658-1329
US

IV. Provider business mailing address

P.O. BOX 9763
NEWPORT BEACH CA
92658
US

V. Phone/Fax

Practice location:
  • Phone: 949-872-3926
  • Fax:
Mailing address:
  • Phone: 949-872-3926
  • Fax: 949-251-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC#52745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: