Healthcare Provider Details

I. General information

NPI: 1023363819
Provider Name (Legal Business Name): THERESA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12630 MONTE VISTA RD STE 202
POWAY CA
92064-2527
US

IV. Provider business mailing address

12630 MONTE VISTA RD STE 202
POWAY CA
92064-2527
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-0727
  • Fax:
Mailing address:
  • Phone: 619-692-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 85610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: