Basic Information
| Provider Information | |||||||||
| NPI: | 1801928916 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORELLANA | ||||||||
| FirstName: | MAYRA | ||||||||
| MiddleName: | YESENIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13361 WENTWORTH ST | ||||||||
| Address2: | |||||||||
| City: | ARLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913316346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187870988 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11565 LAUREL CANYON BLVD STE 1162ND | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913404168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183615030 | ||||||||
| FaxNumber: | 8183611764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 11/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | IMF78074 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.