Healthcare Provider Details

I. General information

NPI: 1558632182
Provider Name (Legal Business Name): IVANA SINDOLIC M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SPORTFISHER DR MHS - FAMILY RECOVERY CENTER
OCEANSIDE CA
92054-2550
US

IV. Provider business mailing address

1100 SPORTFISHER DR MHS - FAMILY RECOVERY CENTER
OCEANSIDE CA
92054-2550
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-6702
  • Fax: 760-439-4779
Mailing address:
  • Phone: 760-439-6702
  • Fax: 760-439-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF55005
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC760
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT95018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: