Basic Information
| Provider Information | |||||||||
| NPI: | 1346536919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISLAS | ||||||||
| FirstName: | AMERICA | ||||||||
| MiddleName: | MARLENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7841 WELLS AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516751860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 E 4TH ST STE 200205 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148248140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 106121 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.