Basic Information
| Provider Information | |||||||||
| NPI: | 1417251133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | CAMPOS | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18200 YORBA LINDA BLVD STE 401 | ||||||||
| Address2: | |||||||||
| City: | YORBA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928864061 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 19742 MACARTHUR BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926122408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146468034 | ||||||||
| FaxNumber: | 7144928264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2011 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT86496 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.