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General NPI Number Information
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NPI Number | 1174413751
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Entity Type | Individual
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Provider Name | ALEXIS MAUI VICIEDO
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Gender | Female
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 08/31/2025
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Provider Practice Location Address
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Address Line | 300 S HARBOR BLVD STE 910
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City | ANAHEIM
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State | CA
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Zip | 92805-3721
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Country | US
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Telephone | 562-821-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 12930 SW 72ND TER
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City | MIAMI
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State | FL
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Zip | 33183-3405
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Country | US
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Telephone | 786-395-5043
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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 | 19933
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License Number State | CA
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