Healthcare Provider Details

I. General information

NPI: 1225345671
Provider Name (Legal Business Name): ROBERTO ERYAN ATTALLA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD SUITE 100
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

6415 OAK AVE
TEMPLE CITY CA
91780-1338
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7464
  • Fax:
Mailing address:
  • Phone: 626-215-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119012
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119012
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: