Healthcare Provider Details

I. General information

NPI: 1386794881
Provider Name (Legal Business Name): MARTHA EDITH ARECHIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO ST
LOS ANGELES CA
90033-1317
US

IV. Provider business mailing address

9808 VENICE BLVD #700
CULVER CITY CA
90232-2732
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-6470
  • Fax:
Mailing address:
  • Phone: 310-945-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberASW73056
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: