Basic Information
| Provider Information | |||||||||
| NPI: | 1548305980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEREDIA | ||||||||
| FirstName: | ALEJANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14415 CORDARY AVE | ||||||||
| Address2: | |||||||||
| City: | HAWTHORNE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902508339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625226405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 370 CRENSHAW BLVD | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905031727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107871500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 10/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW33837 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.