Healthcare Provider Details

I. General information

NPI: 1619244753
Provider Name (Legal Business Name): LORENA CARBAJAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E COMPTON BLVD FL 1
COMPTON CA
90221-3303
US

IV. Provider business mailing address

921 E COMPTON BLVD FL 1
COMPTON CA
90221-3303
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-6800
  • Fax:
Mailing address:
  • Phone: 310-668-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: