Healthcare Provider Details

I. General information

NPI: 1801319116
Provider Name (Legal Business Name): KIMBERLY VALLEJOS KORDI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 11/27/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 LEXINGTON AVE
EL MONTE CA
91731-2607
US

IV. Provider business mailing address

1110 N AVENUE 63
LOS ANGELES CA
90042-1410
US

V. Phone/Fax

Practice location:
  • Phone: 626-453-3399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: