Basic Information
Provider Information
NPI: 1346857166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANCISCO
FirstName: ANA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: ACSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4760 SEPULVEDA BLVD
Address2:  
City: CULVER CITY
State: CA
PostalCode: 902304820
CountryCode: US
TelephoneNumber: 3103906612
FaxNumber: 3103985690
Practice Location
Address1: 4760 SEPULVEDA BLVD
Address2:  
City: CULVER CITY
State: CA
PostalCode: 902304820
CountryCode: US
TelephoneNumber: 3103906612
FaxNumber: 3103985690
Other Information
ProviderEnumerationDate: 09/25/2020
LastUpdateDate: 07/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X83286CAN Behavioral Health & Social Service ProvidersSocial WorkerClinical
101YM0800X83286CAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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