Provider Demographics
NPI:1245918804
Name:BULNES-MENDIZABAL, ALEJANDRO
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:BULNES-MENDIZABAL
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 1:237 N DUNAS ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3423
Mailing Address - Country:US
Mailing Address - Phone:714-585-3710
Mailing Address - Fax:
Practice Address - Street 1:237 N DUNAS ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3423
Practice Address - Country:US
Practice Address - Phone:171-458-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist