Healthcare Provider Details

I. General information

NPI: 1427655620
Provider Name (Legal Business Name): MIKI CHRISTINE COTNER AMFT161620
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32701 VIVENTE DE MARLITA
SAN JUAN CAPISTRANO CA
92675-7118
US

IV. Provider business mailing address

32701 VIVENTE DE MARLITA
SAN JUAN CAPISTRANO CA
92675-7118
US

V. Phone/Fax

Practice location:
  • Phone: 808-492-9920
  • Fax:
Mailing address:
  • Phone: 808-492-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT161620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-14159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: