Provider Demographics
NPI:1558632182
Name:SINDOLIC, IVANA (MA)
Entity Type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:SINDOLIC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SPORTFISHER DR
Mailing Address - Street 2:MHS - FAMILY RECOVERY CENTER
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2550
Mailing Address - Country:US
Mailing Address - Phone:760-439-6702
Mailing Address - Fax:760-439-4779
Practice Address - Street 1:1100 SPORTFISHER DR
Practice Address - Street 2:MHS - FAMILY RECOVERY CENTER
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2550
Practice Address - Country:US
Practice Address - Phone:760-439-6702
Practice Address - Fax:760-439-4779
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF55005106H00000X
CALPCC760101YM0800X
CALMFT95018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist