Provider Demographics
NPI:1174071344
Name:FAVELA, ERIKA (IMF)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:FAVELA
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3482
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-7482
Mailing Address - Country:US
Mailing Address - Phone:714-713-5949
Mailing Address - Fax:
Practice Address - Street 1:10221 SLATER AVE
Practice Address - Street 2:#103
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4748
Practice Address - Country:US
Practice Address - Phone:714-713-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist