Basic Information
Provider Information
NPI: 1861684664
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUGHES
FirstName: STEVE
MiddleName: ANDREW
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2275 S MAIN ST
Address2: STE 201
City: CORONA
State: CA
PostalCode: 928825303
CountryCode: US
TelephoneNumber: 9094997376
FaxNumber: 9512795222
Practice Location
Address1: 2275 S MAIN ST
Address2: STE 201
City: CORONA
State: CA
PostalCode: 928825303
CountryCode: US
TelephoneNumber: 9094997376
FaxNumber: 9512795222
Other Information
ProviderEnumerationDate: 08/15/2007
LastUpdateDate: 10/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X89902CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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