Healthcare Provider Details

I. General information

NPI: 1184093825
Provider Name (Legal Business Name): KRISTELL ARREDONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 W 6TH ST
LOS ANGELES CA
90057-3119
US

IV. Provider business mailing address

470 E. 3RD ST. C
LOS ANGELES CA
90013
US

V. Phone/Fax

Practice location:
  • Phone: 213-351-2835
  • Fax:
Mailing address:
  • Phone: 213-620-5712
  • Fax: 213-621-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77426
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: