Healthcare Provider Details

I. General information

NPI: 1366093668
Provider Name (Legal Business Name): MS. ANA LESLY TAVIRA-NAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 02/26/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 S. WILMINGTON AVE. BLDG #18 SUITE 101
LOS ANGELES CA
90059
US

IV. Provider business mailing address

4139 PARAMOUNT BLVD SPACE 19
PICO RIVERA CA
90660
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-6001
  • Fax: 323-722-4450
Mailing address:
  • Phone: 323-722-4529
  • Fax: 323-722-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: