Healthcare Provider Details

I. General information

NPI: 1730454174
Provider Name (Legal Business Name): IMELDA SINTORA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15405 LANSDOWNE RD
TUSTIN CA
92782-0200
US

IV. Provider business mailing address

400 N TUSTIN AVE STE 120
SANTA ANA CA
92705-3879
US

V. Phone/Fax

Practice location:
  • Phone: 714-949-0228
  • Fax:
Mailing address:
  • Phone: 714-949-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number97167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: