Healthcare Provider Details

I. General information

NPI: 1548742596
Provider Name (Legal Business Name): REBECCA TAFOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/29/2026
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 10TH AVE FL 1
LOS ANGELES CA
90018-4114
US

IV. Provider business mailing address

3609 10TH AVE FL 1
LOS ANGELES CA
90018-4114
US

V. Phone/Fax

Practice location:
  • Phone: 323-298-3680
  • Fax: 323-292-0053
Mailing address:
  • Phone: 323-298-3680
  • Fax: 323-292-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA022260316
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: