Healthcare Provider Details

I. General information

NPI: 1427316777
Provider Name (Legal Business Name): PARTNERSHIPS TO UPLIFT COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N SAN FERNANDO BLVD SUITE 303
BURBANK CA
91504-4182
US

IV. Provider business mailing address

1405 N SAN FERNANDO BLVD SUITE 303
BURBANK CA
91504-4182
US

V. Phone/Fax

Practice location:
  • Phone: 818-478-2082
  • Fax:
Mailing address:
  • Phone: 818-478-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE A ORTIZ
Title or Position: SENIOR ACCOUNTANT
Credential:
Phone: 818-478-2082