Healthcare Provider Details

I. General information

NPI: 1366811101
Provider Name (Legal Business Name): MICAELA THORDARSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE STE 400
ORANGE CA
92868-4243
US

IV. Provider business mailing address

1120 W LA VETA AVE STE 400
ORANGE CA
92868-4243
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8262
  • Fax: 714-509-8266
Mailing address:
  • Phone: 714-509-8262
  • Fax: 714-509-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: