Basic Information
| Provider Information | |||||||||
| NPI: | 1912322892 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINZO | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.A.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8633 KNOTT AVE. | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145276561 | ||||||||
| FaxNumber: | 7145276563 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 S. BROOKHURST RD. | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134491339 | ||||||||
| FaxNumber: | 7144491289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2014 | ||||||||
| LastUpdateDate: | 02/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.