Basic Information
Provider Information | |||||||||
NPI: | 1144501826 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOTFY | ||||||||
FirstName: | NAWAL | ||||||||
MiddleName: | YOUSEF | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3119 S GENOA ST APT D | ||||||||
Address2: |   | ||||||||
City: | ONTARIO | ||||||||
State: | CA | ||||||||
PostalCode: | 917610502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9094566013 | ||||||||
FaxNumber: | 9097731127 | ||||||||
Practice Location | |||||||||
Address1: | 415 W ROUTE 66 STE 202 | ||||||||
Address2: |   | ||||||||
City: | GLENDORA | ||||||||
State: | CA | ||||||||
PostalCode: | 917404335 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6269634467 | ||||||||
FaxNumber: | 6269639543 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/07/2011 | ||||||||
LastUpdateDate: | 09/07/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 50089 | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.