Healthcare Provider Details

I. General information

NPI: 1104758762
Provider Name (Legal Business Name): DE LOS DOS: A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 S SPRING ST STE 400
LOS ANGELES CA
90013-2074
US

IV. Provider business mailing address

453 S SPRING ST STE 400
LOS ANGELES CA
90013-2074
US

V. Phone/Fax

Practice location:
  • Phone: 323-391-4711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: THEADORA ZAVALA RICKER
Title or Position: OWNER
Credential: LCSW
Phone: 323-391-4711