Healthcare Provider Details

I. General information

NPI: 1316611601
Provider Name (Legal Business Name): MAUREEN ANGELA ANCHONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALLERTON ST FL 2
REDWOOD CITY CA
94063-1519
US

IV. Provider business mailing address

500 ALLERTON ST FL 2
REDWOOD CITY CA
94063-1519
US

V. Phone/Fax

Practice location:
  • Phone: 650-599-9955
  • Fax:
Mailing address:
  • Phone: 650-599-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133911
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: