Healthcare Provider Details

I. General information

NPI: 1407988322
Provider Name (Legal Business Name): MRS. ANSELY HENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5628 E SLAUSON AVE
COMMERCE CA
90040-2922
US

IV. Provider business mailing address

5628 E SLAUSON AVE
COMMERCE CA
90040-2922
US

V. Phone/Fax

Practice location:
  • Phone: 661-902-1091
  • Fax:
Mailing address:
  • Phone: 661-902-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: