Basic Information
Provider Information | |||||||||
NPI: | 1285280289 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WAYFINDER FAMILY SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5300 ANGELES VISTA BLVD | ||||||||
Address2: |   | ||||||||
City: | VIEW PARK | ||||||||
State: | CA | ||||||||
PostalCode: | 900431648 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3232954555 | ||||||||
FaxNumber: | 3103213481 | ||||||||
Practice Location | |||||||||
Address1: | 1035 BONITA AVE | ||||||||
Address2: |   | ||||||||
City: | LA VERNE | ||||||||
State: | CA | ||||||||
PostalCode: | 917505109 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9093051948 | ||||||||
FaxNumber: | 9093059822 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/15/2019 | ||||||||
LastUpdateDate: | 06/11/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | VASQUEZ | ||||||||
AuthorizedOfficialFirstName: | NOEMI | ||||||||
AuthorizedOfficialMiddleName: | GARCIA | ||||||||
AuthorizedOfficialTitleorPosition: | DIR OF CONTRACTS & COMPLIANCE | ||||||||
AuthorizedOfficialTelephone: | 3232954555 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/11/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.