Provider Demographics
NPI:1801928916
Name:ORELLANA, MAYRA YESENIA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:YESENIA
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13361 WENTWORTH ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6346
Mailing Address - Country:US
Mailing Address - Phone:818-787-0988
Mailing Address - Fax:
Practice Address - Street 1:11565 LAUREL CANYON BLVD STE 1162ND
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4168
Practice Address - Country:US
Practice Address - Phone:818-361-5030
Practice Address - Fax:818-361-1764
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAIMF78074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist