Individual
MINA OAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
101 THE CITY DR S, ORANGE, CA 92868-3201
(714) 456-8068
(714) 456-3765
Mailing address
200 S MANCHESTER AVE STE 300, ORANGE, CA 92868-3219
(714) 456-2986
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY18651
CA
103T00000X
Psychologist
PSY18651
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY186510
—
CA
Enumeration date
03/15/2007
Last updated
03/21/2023
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