Basic Information
| Provider Information | |||||||||
| NPI: | 1396371126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOERA | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 CORPORATE CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917547620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235264016 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6505 ROSEMEAD BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906603542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626921517 | ||||||||
| FaxNumber: | 5626991378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2020 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 94131 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.