Basic Information
| Provider Information | |||||||||
| NPI: | 1003468034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOBAR | ||||||||
| FirstName: | MAYRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7309 LUXOR ST | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627734794 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6301 BEACH BLVD STE 245 | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148719264 | ||||||||
| FaxNumber: | 7148715032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 05/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT130326 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.