Healthcare Provider Details

I. General information

NPI: 1710739792
Provider Name (Legal Business Name): ISELA CUAHUTLE COUNSELOR-ADDICTION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE STE 101
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

265 S ANITA DR
ORANGE CA
92868-3355
US

V. Phone/Fax

Practice location:
  • Phone: 310-365-7414
  • Fax:
Mailing address:
  • Phone: 949-749-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: