Healthcare Provider Details

I. General information

NPI: 1972258663
Provider Name (Legal Business Name): LIANNE NICOLE RIJOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 ALAMEDA ST
LYNWOOD CA
90262-4023
US

IV. Provider business mailing address

11705 ALAMEDA ST
LYNWOOD CA
90262-4023
US

V. Phone/Fax

Practice location:
  • Phone: 323-568-4979
  • Fax: 323-415-1893
Mailing address:
  • Phone: 323-568-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: