1912669557 NPI number — PA'LANTE THERAPY LICENSED CLINICAL SOCIAL WORKER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912669557 NPI number — PA'LANTE THERAPY LICENSED CLINICAL SOCIAL WORKER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PA'LANTE THERAPY LICENSED CLINICAL SOCIAL WORKER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912669557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3848 TWEEDY BLVD STE B2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH GATE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90280-6168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-522-2629
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9509 MAIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90002-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-633-9804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
YANIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
323-633-9804

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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