Healthcare Provider Details

I. General information

NPI: 1841651817
Provider Name (Legal Business Name): JASIEL CONTRERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 S CENTRAL AVE
LOS ANGELES CA
90011-1237
US

IV. Provider business mailing address

2116 S CENTRAL AVE
LOS ANGELES CA
90011-1237
US

V. Phone/Fax

Practice location:
  • Phone: 213-493-4664
  • Fax: 213-493-4665
Mailing address:
  • Phone: 213-493-4664
  • Fax: 213-493-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: