Basic Information
| Provider Information | |||||||||
| NPI: | 1386855427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POPOWICH | ||||||||
| FirstName: | TRINA | ||||||||
| MiddleName: | MAY-KAMALEI | ||||||||
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| Credential: | MFTT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13901 TUSTIN EAST DR APT 99 | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927801788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146613075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 E CHAPMAN AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928313839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146808200 | ||||||||
| FaxNumber: | 7146808207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.