Healthcare Provider Details

I. General information

NPI: 1043872070
Provider Name (Legal Business Name): NAYELI LIZBETH HERNANDEZ SANTIAGO ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 ARTESIA BLVD STE E
CERRITOS CA
90703-2542
US

IV. Provider business mailing address

11050 ARTESIA BLVD STE E
CERRITOS CA
90703-2542
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-8838
  • Fax: 562-860-0248
Mailing address:
  • Phone: 562-860-8838
  • Fax: 562-860-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACSW104815
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberACSW104815
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW104815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: