Healthcare Provider Details

I. General information

NPI: 1235493669
Provider Name (Legal Business Name): JOANN SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANN PORTER

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 05/07/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18040 SHERMAN WAY
RESEDA CA
91335-4631
US

IV. Provider business mailing address

3580 WILSHIRE BLVD STE 800
LOS ANGELES CA
90010-2505
US

V. Phone/Fax

Practice location:
  • Phone: 213-637-5000
  • Fax: 213-637-5001
Mailing address:
  • Phone: 213-637-5000
  • Fax: 213-637-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number70764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: