Healthcare Provider Details

I. General information

NPI: 1043603715
Provider Name (Legal Business Name): ANDREA KIMIKO SUGINO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 NEWPORT AVE
TUSTIN CA
92780-2711
US

IV. Provider business mailing address

PO BOX 10994
COSTA MESA CA
92627-0994
US

V. Phone/Fax

Practice location:
  • Phone: 714-803-4866
  • Fax:
Mailing address:
  • Phone: 714-805-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: