Healthcare Provider Details

I. General information

NPI: 1861773046
Provider Name (Legal Business Name): MS. CLAUDIA CONSUELO LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 CAMINO DEL RIO S STE 407
SAN DIEGO CA
92108-4028
US

IV. Provider business mailing address

3517 CAMINO DEL RIO S STE 407
SAN DIEGO CA
92108-4028
US

V. Phone/Fax

Practice location:
  • Phone: 619-955-8905
  • Fax: 619-955-8906
Mailing address:
  • Phone: 619-955-8905
  • Fax: 619-955-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number96231
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW60908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: