Basic Information
| Provider Information | |||||||||
| NPI: | 1710017264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA-CRISANTO | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | MARILENA | ||||||||
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| NameSuffix: | X | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918014385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263009060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 840 N AVENUE 66 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900421508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232579600 | ||||||||
| FaxNumber: | 3239992451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 06/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | MFC 52110 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.