Healthcare Provider Details

I. General information

NPI: 1770406571
Provider Name (Legal Business Name): DARIANN RAYNELL MODELISTE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20409 YORBA LINDA BLVD STE K2
YORBA LINDA CA
92886-3042
US

IV. Provider business mailing address

2576 E 218TH ST
LONG BEACH CA
90810-1711
US

V. Phone/Fax

Practice location:
  • Phone: 714-485-7771
  • Fax:
Mailing address:
  • Phone: 310-429-3864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: