Healthcare Provider Details

I. General information

NPI: 1184793572
Provider Name (Legal Business Name): MRS. VANESSA M. THOMAS-BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S GRAND AVE
SANTA ANA CA
92705-4434
US

IV. Provider business mailing address

3171 OAK KNOLL DR
LOS ALAMITOS CA
90720-4516
US

V. Phone/Fax

Practice location:
  • Phone: 714-567-7681
  • Fax: 714-834-6825
Mailing address:
  • Phone: 562-430-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC37210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: