Healthcare Provider Details

I. General information

NPI: 1801711460
Provider Name (Legal Business Name): CZARINA DE JESUS, MARRIAGE AND FAMILY THERAPIST INC.
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

1001 DOVE ST STE 270
NEWPORT BEACH CA
92660-2851
US

IV. Provider business mailing address

1001 DOVE ST STE 270
NEWPORT BEACH CA
92660-2851
US

V. Phone/Fax

Practice location:
  • Phone: 949-274-9524
  • Fax:
Mailing address:
  • Phone: 949-274-9524
  • Fax:

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: CZARINA DE JESUS
Title or Position: LICENSED MFT
Credential:
Phone: 949-274-9524