Provider Information for 1801302633
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Mrs. OCTAVIA RUSU FUKINO LMFT #94660 LPCC#461
Other Names:Former Name:Mrs. OCTAVIA GAVRILASex: Female
NPI: 1801302633
Last Updated: 2017-12-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1801302633 | ||||||||||||
| Enumeration Date | 2017-12-15 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 7206 HAVENROCK DR HUNTINGTON BEACH, CA 92648-3006 United States Phone: 714-882-9811 | Fax: | ||||||||||||
| Primary Practice Address | 250 EL CAMINO REAL STE 206 TUSTIN, CA 92780-3656 United States Phone: 714-882-9811 | Fax:714-882-9811 | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|