Healthcare Provider Details

I. General information

NPI: 1720891781
Provider Name (Legal Business Name): CLAIRE KANEKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 YORBA LINDA BLVD STE 106
YORBA LINDA CA
92886-4006
US

IV. Provider business mailing address

18200 YORBA LINDA BLVD STE 111
YORBA LINDA CA
92886-4043
US

V. Phone/Fax

Practice location:
  • Phone: 714-646-8034
  • Fax: 714-492-8264
Mailing address:
  • Phone: 714-646-8034
  • Fax: 714-492-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT150440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: