Healthcare Provider Details

I. General information

NPI: 1164547832
Provider Name (Legal Business Name): MARINA ELAINE MONTERROSA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S LA FAYETTE PARK PL FL 3
LOS ANGELES CA
90057-1607
US

IV. Provider business mailing address

520 SO. LAFAYETTE PK. PL. 3RD FLOOR
LOS ANGELES CA
90057
US

V. Phone/Fax

Practice location:
  • Phone: 213-252-2100
  • Fax: 213-383-3146
Mailing address:
  • Phone: 213-252-2100
  • Fax: 213-383-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96552
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: