Basic Information
| Provider Information | |||||||||
| NPI: | 1255908992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RESENDIZ | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25402 PACIFICA AVE | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926913854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492382400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25402 PACIFICA AVE | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926913854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492382400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2021 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 126309 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.