Healthcare Provider Details

I. General information

NPI: 1831744085
Provider Name (Legal Business Name): DANIELA EKATERINA SARMINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 VINE ST
LOS ANGELES CA
90038-1612
US

IV. Provider business mailing address

1224 VINE ST
LOS ANGELES CA
90038-1612
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-6100
  • Fax: 323-467-0297
Mailing address:
  • Phone: 323-769-6100
  • Fax: 323-467-0297

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 Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW122369
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW96508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: