Basic Information
| Provider Information | |||||||||
| NPI: | 1528622206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRECIADO | ||||||||
| FirstName: | ABRAHAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3208 ROSEMEAD BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262277014 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3208 ROSEMEAD BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262277014 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2019 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 85945 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 110968 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.