Provider Demographics
NPI:1407908684
Name:MESTYANEK, MARC JOSEPH
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:JOSEPH
Last Name:MESTYANEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 RAYFORD DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2430
Mailing Address - Country:US
Mailing Address - Phone:310-259-0458
Mailing Address - Fax:
Practice Address - Street 1:23041 AVENIDA DE LA CARLOTA FL 4
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1511
Practice Address - Country:US
Practice Address - Phone:714-644-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist