Provider Demographics
NPI:1851720742
Name:MAULIT, VIVIANA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:VIVIANA
Middle Name:
Last Name:MAULIT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:VIVIANA
Other - Middle Name:
Other - Last Name:PALACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2101 S STANDARD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3003
Mailing Address - Country:US
Mailing Address - Phone:714-277-8124
Mailing Address - Fax:
Practice Address - Street 1:4000 W METROPOLITAN DR # 405
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:714-645-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104024106H00000X
CA10002539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist