Healthcare Provider Details

I. General information

NPI: 1356266811
Provider Name (Legal Business Name): NELLY PAMELA DE ARCOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 W 147TH ST
LAWNDALE CA
90260-1709
US

IV. Provider business mailing address

10734 FIRMONA AVE
INGLEWOOD CA
90304-1823
US

V. Phone/Fax

Practice location:
  • Phone: 310-973-1300
  • Fax:
Mailing address:
  • Phone: 424-206-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: