Healthcare Provider Details

I. General information

NPI: 1760765697
Provider Name (Legal Business Name): VILMA CULAJAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST # MC122
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

20430 HAWTHORNE BLVD
TORRANCE CA
90503-2404
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone: 424-212-5051
  • Fax: 424-212-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number70922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: