Basic Information
| Provider Information | |||||||||
| NPI: | 1689119976 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALCANTARA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | YAMILET | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15339 SATICOY ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182672646 | ||||||||
| FaxNumber: | 8182672996 | ||||||||
| Practice Location | |||||||||
| Address1: | 15339 SATICOY ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182672646 | ||||||||
| FaxNumber: | 8182672996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF100875 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | LMFT120223 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.