Healthcare Provider Details

I. General information

NPI: 1386450690
Provider Name (Legal Business Name): ST. ANNE'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

IV. Provider business mailing address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

V. Phone/Fax

Practice location:
  • Phone: 213-812-9313
  • Fax:
Mailing address:
  • Phone: 213-760-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACPUELINE ZAVALA
Title or Position: CLINICAL AND ADMINISTRATIVE SITE SU
Credential: LCSW
Phone: 323-381-2931