Healthcare Provider Details

I. General information

NPI: 1528308111
Provider Name (Legal Business Name): JUNE PUTHASOMBAT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2603
US

IV. Provider business mailing address

10032 ROSE ST
BELLFLOWER CA
90706-6917
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax:
Mailing address:
  • Phone: 562-676-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: