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NPI Code Detail

MEDICARE: ERIC DE AENLLE

MEDICARE: ERIC DE AENLLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist146258CA

General Provider Information

NPI Number : 1366839797
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC DE AENLLE
Provider Business Mailing Address
First Line : 1320 W PEARL ST
Second Line :
City : ANAHEIM
State : CA
Zip : 92801-5941
Country : US
Telephone Number : 714-780-1174
Fax Number :
Provider Business Practice Location Address
First Line : 1320 W PEARL ST
Second Line :
City : ANAHEIM
State : CA
Zip : 92801-5941
Country : US
Telephone Number : 714-780-1174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2015
Last Update Date : 04/08/2025

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Directions to “ ERIC DE AENLLE ” Practice Location

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