Provider Demographics
NPI:1699833988
Name:VEVAINA, TINAZ S (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:TINAZ
Middle Name:S
Last Name:VEVAINA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BIRCH ST
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2211
Mailing Address - Country:US
Mailing Address - Phone:949-466-5176
Mailing Address - Fax:949-757-0234
Practice Address - Street 1:4000 BIRCH ST
Practice Address - Street 2:SUITE # 203
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2211
Practice Address - Country:US
Practice Address - Phone:949-466-5176
Practice Address - Fax:949-757-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist