Healthcare Provider Details

I. General information

NPI: 1255895066
Provider Name (Legal Business Name): DAPHNE ALEXIS CIFUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S BRAND BLVD
SAN FERNANDO CA
91340-4040
US

IV. Provider business mailing address

17730 LASSEN ST APT 305
NORTHRIDGE CA
91325-4769
US

V. Phone/Fax

Practice location:
  • Phone: 818-714-2275
  • Fax:
Mailing address:
  • Phone: 818-300-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: