Healthcare Provider Details

I. General information

NPI: 1922246776
Provider Name (Legal Business Name): AMANDA EMMA DE LOERA-MORALES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 S VERMONT AVE
LOS ANGELES CA
90007-3033
US

IV. Provider business mailing address

3031 S VERMONT AVE
LOS ANGELES CA
90007-3033
US

V. Phone/Fax

Practice location:
  • Phone: 323-373-2400
  • Fax:
Mailing address:
  • Phone: 323-356-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: