Basic Information
| Provider Information | |||||||||
| NPI: | 1982953584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODAS HURTADO | ||||||||
| FirstName: | PRICILA | ||||||||
| MiddleName: | MIUZETT | ||||||||
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| Credential: | LCSW 94415 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2502 E. HUNTINGTON DR. | ||||||||
| Address2: | |||||||||
| City: | DUARTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262806510 | ||||||||
| FaxNumber: | 6262888903 | ||||||||
| Practice Location | |||||||||
| Address1: | 8263 GROVE AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917303107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095790708 | ||||||||
| FaxNumber: | 9095790778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2012 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW71518 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 94415 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.