Provider Demographics
NPI:1164271813
Name:SOARES, RAYRA MARIA (R1560210524)
Entity type:Individual
Prefix:
First Name:RAYRA
Middle Name:MARIA
Last Name:SOARES
Suffix:
Gender:F
Credentials:R1560210524
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 JAVA RD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3552
Mailing Address - Country:US
Mailing Address - Phone:818-577-7084
Mailing Address - Fax:
Practice Address - Street 1:3029 JAVA RD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3552
Practice Address - Country:US
Practice Address - Phone:818-577-7084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1560210524101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor