Healthcare Provider Details

I. General information

NPI: 1629653209
Provider Name (Legal Business Name): ANTHONY RESCIGNO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W 190TH ST STE A
GARDENA CA
90248-4235
US

IV. Provider business mailing address

451 CARROLL CANAL
VENICE CA
90291-4683
US

V. Phone/Fax

Practice location:
  • Phone: 562-306-2925
  • Fax:
Mailing address:
  • Phone: 424-207-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT124478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: