Basic Information
| Provider Information | |||||||||
| NPI: | 1104107572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUMBAGA | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1974 HUNTINGTON DR # 4S | ||||||||
| Address2: | |||||||||
| City: | S PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910305620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134841186 | ||||||||
| FaxNumber: | 2133531119 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 S SAN PEDRO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900132148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136220867 | ||||||||
| FaxNumber: | 2136221801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2011 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.