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General NPI Number Information
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NPI Number | 1134353832
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Entity Type | Individual
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Provider Name | MAYRA ALBERTINI BULLON LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 23822 VALENCIA BLVD. SUITE 203
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City | VALENCIA
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State | CA
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Zip | 91355
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Country | US
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Telephone | 310-753-2212
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Fax | 661-678-0711
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Provider Business Mailing Address
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Address Line | 22456 SMILEY CT
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City | SANTA CLARITA
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State | CA
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Zip | 91350
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Country | US
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Telephone | 301-753-2212
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Fax | 661-678-0711
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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 | MFC 51475
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License Number State | CA
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