1134353832 NPI number — MAYRA ALBERTINI BULLON LMFT

Table of content: MAYRA ALBERTINI BULLON LMFT (NPI 1134353832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134353832 NPI number — MAYRA ALBERTINI BULLON LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLON
Provider First Name:
MAYRA
Provider Middle Name:
ALBERTINI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134353832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22456 SMILEY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CLARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-753-2212
Provider Business Mailing Address Fax Number:
661-678-0711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23822 VALENCIA BLVD.
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-753-2212
Provider Business Practice Location Address Fax Number:
661-678-0711
Provider Enumeration Date:
05/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 51475 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com