Healthcare Provider Details

I. General information

NPI: 1659772333
Provider Name (Legal Business Name): LORALEI BINGAMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE. 590
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

19717 THORNLAKE AVE
CERRITOS CA
90703-7726
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax:
Mailing address:
  • Phone: 562-682-5418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: