Healthcare Provider Details

I. General information

NPI: 1245357250
Provider Name (Legal Business Name): JAIME G AZNAR L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W VICTORIA ST
GARDENA CA
90248-3523
US

IV. Provider business mailing address

207 LOMA VISTA ST
EL SEGUNDO CA
90245-3633
US

V. Phone/Fax

Practice location:
  • Phone: 310-715-2020
  • Fax:
Mailing address:
  • Phone: 310-322-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS24640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: