Healthcare Provider Details

I. General information

NPI: 1316006265
Provider Name (Legal Business Name): MS. LUCIA PAULA FURUTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCIA LANZADERAS FURUTA MSW

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 N. DALY ST.
LOS ANGELES CA
90031
US

IV. Provider business mailing address

419 WILLAPA LANE
DIAMOND BAR CA
91765
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-4800
  • Fax:
Mailing address:
  • Phone: 714-930-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 16071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: