Basic Information
| Provider Information | |||||||||
| NPI: | 1427519784 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WAYFINDER FAMILY SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WAYFINDER FAMILY SERVICES-LAVERNE-ISFC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 ANGELES VISTA BLVD | ||||||||
| Address2: | |||||||||
| City: | VIEW PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900431648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232954555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1045 BONITA AVE | ||||||||
| Address2: | |||||||||
| City: | LA VERNE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917505109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093051948 | ||||||||
| FaxNumber: | 9093059822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VASQUEZ | ||||||||
| AuthorizedOfficialFirstName: | NOEMI | ||||||||
| AuthorizedOfficialMiddleName: | GARCIA | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CONTRACTS & COMPLAINCE | ||||||||
| AuthorizedOfficialTelephone: | 3232954555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253J00000X | N | Agencies | Foster Care Agency | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.