Healthcare Provider Details

I. General information

NPI: 1750621918
Provider Name (Legal Business Name): ERICA JARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY BUILDING 606 SOCIAL WORK
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

7601 IMPERIAL HWY BUILDING 606 SOCIAL WORK
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 562-396-6710
  • Fax: 562-401-6645
Mailing address:
  • Phone: 562-396-6710
  • Fax: 562-401-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 25784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: