Healthcare Provider Details

I. General information

NPI: 1164229936
Provider Name (Legal Business Name): COMMUNIDAD EN OUTREACH FOR RESILIENCE AND AWARENESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E WASHINGTON BLVD UNIT C
LOS ANGELES CA
90021-3035
US

IV. Provider business mailing address

1201 E WASHINGTON BLVD UNIT C
LOS ANGELES CA
90021-3035
US

V. Phone/Fax

Practice location:
  • Phone: 310-866-6703
  • Fax:
Mailing address:
  • Phone: 310-866-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN TAFOYA
Title or Position: CLINICAL DIRECRTOR
Credential: LCSW
Phone: 310-866-6703