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General NPI Number Information
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NPI Number | 1265850028
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Entity Type | Individual
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Provider Name | VIVIANNA LOUISE NIETO-FOUST LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2014
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 250 EL CAMINO REAL STE 213
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City | TUSTIN
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State | CA
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Zip | 92780-3656
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Country | US
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Telephone | 714-823-8330
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 N GRAND AVE 10433
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City | SANTA ANA
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State | CA
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Zip | 92711-9998
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Country | US
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Telephone | 714-823-8330
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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 | 24059
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License Number State | CA
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