Basic Information
| Provider Information | |||||||||
| NPI: | 1184083339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALSTON | ||||||||
| FirstName: | CHANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1045 ECLIPSE CT | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917624804 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8220 S SAN PEDRO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235700445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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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 | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | IMF90775 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.