Healthcare Provider Details

I. General information

NPI: 1558285825
Provider Name (Legal Business Name): MOSES ACEVEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE STE 208
ORANGE CA
92868-4448
US

IV. Provider business mailing address

705 W LA VETA AVE STE 208
ORANGE CA
92868-4448
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-9295
  • Fax: 714-532-9291
Mailing address:
  • Phone: 714-532-9295
  • Fax: 714-532-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: