Healthcare Provider Details

I. General information

NPI: 1396681144
Provider Name (Legal Business Name): CAROLINA AMBRIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 S AVENUE 19 UNIT 6
LOS ANGELES CA
90031-3211
US

IV. Provider business mailing address

528 S AVENUE 19 UNIT 6
LOS ANGELES CA
90031-3211
US

V. Phone/Fax

Practice location:
  • Phone: 323-241-9283
  • Fax:
Mailing address:
  • Phone: 323-241-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: