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General NPI Number Information
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NPI Number | 1073009700
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Entity Type | Individual
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Provider Name | EVA E KUNCEWICKI
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Gender | Female
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 1001 S GRAND AVE # B
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City | SANTA ANA
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State | CA
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Zip | 92705
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Country | US
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Telephone | 714-667-7613
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 BELMONT AVE
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City | LONG BEACH
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State | CA
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Zip | 90804-4227
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Country | US
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Telephone | 949-510-6689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 105613
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License Number State | CA
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