Healthcare Provider Details

I. General information

NPI: 1477076313
Provider Name (Legal Business Name): MS. VALERIA PAOLA CHICHIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W WALNUT ST STE 375
PASADENA CA
91124-4002
US

IV. Provider business mailing address

10255 TUNNEY AVE
NORTHRIDGE CA
91324-1042
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 818-497-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT128049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: