Healthcare Provider Details

I. General information

NPI: 1679105753
Provider Name (Legal Business Name): MYLENE PAGDANGANAN EDUVALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SYCAMORE AVE STE 270
VISTA CA
92081-7852
US

IV. Provider business mailing address

FILE 57326
LOS ANGELES CA
90074-7326
US

V. Phone/Fax

Practice location:
  • Phone: 800-926-8273
  • Fax: 888-539-8781
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: