Basic Information
| Provider Information | |||||||||
| NPI: | 1407186588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EFAH | ||||||||
| FirstName: | ERNEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11731 TELEGRAPH RD STE G | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906706819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | 5629493587 | ||||||||
| Practice Location | |||||||||
| Address1: | 11731 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | 5629493587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2010 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW97070 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | ASW97070 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.