Healthcare Provider Details

I. General information

NPI: 1174316798
Provider Name (Legal Business Name): ERIKA MARIBEL LLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21505 NORWALK BLVD
HAWAIIAN GARDENS CA
90716-1121
US

IV. Provider business mailing address

861 N HAMILTON BLVD
POMONA CA
91768-2929
US

V. Phone/Fax

Practice location:
  • Phone: 562-916-7581
  • Fax:
Mailing address:
  • Phone: 909-802-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: