Basic Information
| Provider Information | |||||||||
| NPI: | 1922655091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINONES | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | ANDRE | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5706 KESTER AVE APT 6 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914113317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073616517 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5849 CROCKER ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234324383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2019 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.