Healthcare Provider Details

I. General information

NPI: 1619557683
Provider Name (Legal Business Name): ANDREA JASMIN EMITERIO PASCUAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W KATELLA AVE STE 150
ORANGE CA
92867-3432
US

IV. Provider business mailing address

333 W BROADWAY UNIT 874
ANAHEIM CA
92815-2040
US

V. Phone/Fax

Practice location:
  • Phone: 714-399-3480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT161523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: