Provider Demographics
NPI:1831448166
Name:MARIPOSA WOMEN AND FAMILY CENTER
Entity type:Organization
Organization Name:MARIPOSA WOMEN AND FAMILY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:714-547-6494
Mailing Address - Street 1:29222 RANCHO VIEJO RD STE 123
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1044
Mailing Address - Country:US
Mailing Address - Phone:714-547-6494
Mailing Address - Fax:714-547-9990
Practice Address - Street 1:29222 RANCHO VIEJO RD STE 123
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1044
Practice Address - Country:US
Practice Address - Phone:714-547-6494
Practice Address - Fax:714-547-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health