Healthcare Provider Details

I. General information

NPI: 1013804004
Provider Name (Legal Business Name): JOSE QUIROZ-NOVELA AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD STE 327
LOS ANGELES CA
90025-7207
US

IV. Provider business mailing address

PO BOX 18011
LOS ANGELES CA
90018-0011
US

V. Phone/Fax

Practice location:
  • Phone: 314-312-2201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: