Healthcare Provider Details

I. General information

NPI: 1073866356
Provider Name (Legal Business Name): MIGUEL MACIAS TORRES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S PACIFIC COAST HWY STE 209
REDONDO BEACH CA
90277-3737
US

IV. Provider business mailing address

326 S PACIFIC COAST HWY STE 209
REDONDO BEACH CA
90277-3737
US

V. Phone/Fax

Practice location:
  • Phone: 213-493-6341
  • Fax: 213-816-1977
Mailing address:
  • Phone: 213-493-6341
  • Fax: 213-816-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number91413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: