Healthcare Provider Details

I. General information

NPI: 1164930624
Provider Name (Legal Business Name): ANA ISABEL LOORYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 PALM ST
LEMON GROVE CA
91945-3026
US

IV. Provider business mailing address

3434 GROVE ST
LEMON GROVE CA
91945-1812
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-1090
  • Fax:
Mailing address:
  • Phone: 619-797-1090
  • Fax: 619-797-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: