1710033089 NPI number — MRS. JACQUELINE YVONNE PEARSON MFT

Table of content: MRS. JACQUELINE YVONNE PEARSON MFT (NPI 1710033089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710033089 NPI number — MRS. JACQUELINE YVONNE PEARSON MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
JACQUELINE
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
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:
1710033089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33462 DOSINIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-4490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-496-7782
Provider Business Mailing Address Fax Number:
949-458-1586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25283 CABOT RD STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-458-8145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2007

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 32479 , 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)





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