Healthcare Provider Details

I. General information

NPI: 1114302528
Provider Name (Legal Business Name): VIENA VAI VAKA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 65
REDWOOD CITY CA
94064-0065
US

IV. Provider business mailing address

PO BOX 65
REDWOOD CITY CA
94064-0065
US

V. Phone/Fax

Practice location:
  • Phone: 650-503-3995
  • Fax:
Mailing address:
  • Phone: 650-503-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number151893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: