Basic Information
| Provider Information | |||||||||
| NPI: | 1215658067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLIVEN | ||||||||
| FirstName: | MA LOURDES | ||||||||
| MiddleName: | TAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12325 IMPERIAL HWY # 130 | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906508304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142498881 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12440 FIRESTONE BLVD STE 3001 | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906504300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668696608 | ||||||||
| FaxNumber: | 4243786329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2022 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT134051 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.