Healthcare Provider Details

I. General information

NPI: 1639596299
Provider Name (Legal Business Name): YADIRA DANTZLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14807 LONGWORTH AVE
NORWALK CA
90650-5671
US

IV. Provider business mailing address

14807 LONGWORTH AVE
NORWALK CA
90650-5671
US

V. Phone/Fax

Practice location:
  • Phone: 323-377-2973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95276151
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95038274
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW60829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: