Provider Demographics
NPI:1780232892
Name:UEHARA, MALLORY FRANCES (MA)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:FRANCES
Last Name:UEHARA
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 1:600 ANTON BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7100
Mailing Address - Country:US
Mailing Address - Phone:714-866-7100
Mailing Address - Fax:
Practice Address - Street 1:600 ANTON BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7100
Practice Address - Country:US
Practice Address - Phone:714-866-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-01
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician