Healthcare Provider Details

I. General information

NPI: 1407002397
Provider Name (Legal Business Name): LIDIA TOVAR L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD SUITE 110
HAWAIIAN GARDENS CA
90716-2603
US

IV. Provider business mailing address

8526 1/2 ROSE ST
BELLFLOWER CA
90706-6323
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax: 562-865-5244
Mailing address:
  • Phone: 562-246-5700
  • Fax: 562-246-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: