Healthcare Provider Details

I. General information

NPI: 1104731868
Provider Name (Legal Business Name): ERWIN ORLANDO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 E COVINA BLVD
COVINA CA
91724-1523
US

IV. Provider business mailing address

105 N LARK ELLEN AVE
WEST COVINA CA
91791-1300
US

V. Phone/Fax

Practice location:
  • Phone: 800-654-2673
  • Fax:
Mailing address:
  • Phone: 800-654-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: