Healthcare Provider Details

I. General information

NPI: 1710208293
Provider Name (Legal Business Name): FLOR YOUSEFIAN TEHRANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FLORIN YOUSEFIAN

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GRAND AVE
SANTA ANA CA
92705-4121
US

IV. Provider business mailing address

2777 ALTON PKWY APT 368
IRVINE CA
92606-3143
US

V. Phone/Fax

Practice location:
  • Phone: 714-687-6740
  • Fax: 714-667-7717
Mailing address:
  • Phone: 949-387-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 60600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: