Healthcare Provider Details

I. General information

NPI: 1922491141
Provider Name (Legal Business Name): CHARMILL DORMETRA VEGA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W TOWN AND COUNTRY RD # 100
ORANGE CA
92868-4713
US

IV. Provider business mailing address

PO BOX 347
BARSTOW CA
92312-0347
US

V. Phone/Fax

Practice location:
  • Phone: 877-577-7267
  • Fax:
Mailing address:
  • Phone: 760-308-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT133862
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT133682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: