Basic Information
| Provider Information | |||||||||
| NPI: | 1699256354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONTRERAS | ||||||||
| FirstName: | ERNESTO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1529 E PALMDALE BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935502038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615751800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1529 E PALMDALE BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935502038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615751800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 05/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW89800 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | ASW89800 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.